The CARER+ Digital Competence Framework. for Care workers and Caregivers

Transcription

1 The CARER+ Digital Competence Framework for Care workers and Caregivers 1

2 D2.2 CARER+ Digital Competence Framework for Care Workers and Caregivers Deliverable Title Deliverable Lead Work package WP 2 Author(s) Contributor(s) Reviewer(s) Dissemination level D2.2 CARER+ Digital Competence Framework for Care Workers and Caregivers 3s Unternehmensberatung GmbH Lubomir Valenta Petra Ziegler, Maria Kargl Margarita Perez Garcia, Stylianos Hatzipanagos public Project Number Instrument Start date of Project 09/03/2012 Duration Project coordinator CIP ICT PSP Pilot B 36 months IFEF IPERIA Abstract This document presents the CARER+ Digital Competence Framework for care workers and caregivers which is the key product of Work Package 2: Identification of ICT knowledge and skill-based competences for domiciliary care workers and caregivers. In Chapter 2, the methodology of the empirical research is summarised and selected evidence introduced. Chapter 3 elaborates on the analysis of related projects, initiatives and frameworks. Chapter 4 outlines the logic of the CARER+ Digital Competence Framework design and gives overview of its structural elements. The resulting product is delivered in Chapter 5, through a summarising 3-dimensional display as well as through the set of 5-dimensional competence cards. Full account of the research outputs is found in Annexes. 2

3 Quality control checklist Quality Control Check Tick box Generic Minimum Quality Standards Document Abstract provided Document Summary provided (with adequate synopsis of contents) CARER+ format standards complied with Language, grammar and spelling acceptable Objectives of Description of Work covered Work deliverable relates to adequately covered Quality of text is acceptable (organisation and structure; diagrams; readability) Comprehensiveness is acceptable (no missing sections; missing references; unexplained arguments) Usability is acceptable (deliverable provides clear information in a form that is useful to the reader) Deliverable specific quality criteria Deliverable meets the 'acceptance Criteria' set out in the Quality Register For Key Deliverables only Deliverable approved by external reviewers Checklist completed and deliverable approved by Name: Signature: Date: Final checklist to be completed and deliverable signed off by primary reviewer 3

4 Document review history Version Name Status * Date Summary of changes 1 Lubomir Valenta A 14/04/2013 First draft 2 Stylianos Hatzipanagos SIR 20/05/13 3 Margarita Perez Garcia PIR 20/05/13 *Status: Indicate if: A - Author (including author of revised deliverable) PIR Primary internal reviewer SIR Second internal reviewer ER External Reviewer 4

5 Licence and copyright CARER+, 2013 The content of this document does not reflect the official opinion of the European Union. Responsibility for the information and views expressed in therein lies entirely with the authors. The document is prepared in the framework of the CARER+ project co-funded by the Competitiveness and Innovation framework Programme - ICT Policy Support Programme. 5

6 Table of contents QUALITY CONTROL CHECKLIST 3 DOCUMENT REVIEW HISTORY 4 LICENCE AND COPYRIGHT 5 TABLE OF CONTENTS 6 1. EXECUTIVE SUMMARY 7 2. RESEARCH METHODOLOGY AND OUTCOMES CONTEXT ANALYSIS LOGIC AND DESIGN THE CARER+ DIGITAL COMPETENCE FRAMEWORK REFERENCES ANNEXES 94 6

7 1. Document summary This document presents the proposal for a CARER+ Digital Competence Framework (DCF) for care workers and caregivers that has been produced within the project s Work Package 2: Identification of ICT knowledge and skill-based competences for domiciliary caregivers and care workers. Two lines of research activities have informed the development of the DCF. Firstly, empirical research in seven European countries was carried out combining qualitative and quantitative methods to inquire into the central topics of WP2 interest: relevance of digital competence in the care sector; possibilities for applying digital competence in care work in near future; specific digital competences needed by carers and relevance for care recipients. Within this line of research, a document analysis was conducted, expert focus groups organised, individual expert interviews held, and a questionnaire survey was disseminated among care work practitioners. The research outputs collected are: 57 competence-related documents analysed (curricula, qualifications standards, occupations standards, etc.) 8 expert focus groups organised 46 expert interviews conducted 156 questionnaires returned by care workers and caregivers The evidence collected and reported through the above outputs was analysed and mapped on various versions of the DCF structure, and contributed to the definition of competence categories as well as the related learning outcomes.. Secondly, a context analysis was carried out examining a number of international projects on digital competence and social care work including related literature. Three major digital frameworks were analysed in closer detail: The European Computer Driving Licence (ECDL), the European e-competence Framework (e-cf), and the Framework for Developing and Understanding Digital Competence in Europe (DIGCOMP). Particularly the DIGCOMP initiative developed by the European Commission Joint Research Centre proved, despite being still in progress, to be a key source of information on general digital competence architecture of our framework. In line with the DIGCOMP approach as well as with the latest developments in the conceptualisation of competences and learning outcomes, the CARER+ DCF adopts the understanding of digital competence as a multi-faceted entity of practical/instrumental knowledge and skills, soft and transversal skills and capabilities, and personal attitudes and values. To transfer the concept of general digital competence into the specific context and needs of domiciliary care, the CARER+ DCF is designed around three Competence Domains: 7

8 Domain A: General digital competence (DIGCOMP adapted) > Competences relevant for the development of general ICT literacy. Domain B: Enabling digital competence in social care work > Competences to make the application of digital technology possible, sustainable and accepted by both care workers and care recipients. Domain C: Occupation-specific and advanced digital competence in care work > Competences focused on care sector-specific digital technologies, and on enhancing the employability of carers through occupation-specific digital competence. The DCF structural elements are organised according to five dimensions: 3 Competence Domains 12 Competence Areas 48 Competences 2 Application Levels Examples of Learning Outcomes The following diagram represents the high-level structure of the CARER+ DCF, illustrating the dimensions of Domains (central circle) and Competence Areas (square objects), and indicating the numbers of single Competences in each Domain (numeric circles): 8

9 The red section in the diagram represents Domain A: General digital competence. It contains 19 Competences distrubuted into 4 Competence Areas. This Domain builds on, and adapts, the DIGCOMP framework: four out of five DIGCOMP Competence Areas were used including their Competences. Corresponding examples of learning outcomes defined by DIGCOMP were also adopted (in the User Application Level) and complemented with new examples defined for the Mentor/Guide Level. The resulting set of Competences refers to the ability to use digital technologies in general, and to mediate this ability to others. The blue section in the diagram represents Domain B: Enabling digital competence in care. The 4 Competence Areas and 13 Competences therein address one of our principal research findings, namely that a digitally competent care worker or caregiver will be expected not only to apply general digital literacy but also to make the concept of digital competence meaningful and accepted in the context of his/her work. In the perspective of the two Application Levels this means enabling digital competence both in the carers own work practices and in the care recipients perception and adoption of digital technologies. The Domain B, therefore, contains soft skills, interpersonal abilities and transversal competences linked with digital knowledge, skills and attitudes. The yellow section of the diagram represents Domain C: Occupation-specific and advanced digital competence. The elements contained therein (4 Competence Areas comprising 16 Competences) refer to the aspects of digital competence that are not general-user oriented but address the digital technologies, tasks and usage scenarios found specifically in social care work. These include different kinds of solutions such as telecare digital arrangements, ehealth and assistive technologies. Also in this Domain, competences are included that relate to care workers further development and employability, ranging from the ability to administer care work using digital technology to the ability to seek the recognition and/or certification of own digital learning outcomes. We foresee three elementary purposes of the Carer+ Digital Competence Framework. The tool will: inform and contribute to the next outcomes and activities within the Carer+ project, in particular the Work Package 4: Development of the learning environment, pathways and resources. serve interested external stakeholders such as IVET and CVET providers or enterprises to define training programmes, modules, competence standards or occupation standards. In this scenario the Framework can serve as a general orientation mechanism / organising principle or simply as a source of competence description and examples of learning outcomes. contribute to the discussion on digital competence in social care work among experts, researchers, project teams and policy makers. 9

10 2. Research methodology and outcomes This chapter 1 outlines the conceptual background, methodology, and evidence-based results of the research carried out to inform the development of a CARER+ Digital Competence Framework for care workers in the domiciliary care sector Introduction Today it is possible for almost everyone to receive the care they need at home, even if they suffer from chronic illnesses. Yet frail older people still move to assisted living facilities or nursing homes. For many, that transition is driven by a lack of qualified caregivers, an absence of basic services such as transportation, no access to appropriate housing, and loneliness. Recent research has shown that a large segment of the growing number of older people in Europe can be encouraged to use technology-based services, and that ICTs (Information and Communication Technologies) and AAL (Ambient Assisted Living) technologies can radically improve their quality of life by supporting ageing well in the community and at home. The key mediator between these ICT-based opportunities and their integration into older people s lives stands in the available human resource represented by the domiciliary care workers and the set of competences they possess. In recent years a number of initiatives and projects have reflected on the need to map the role of digital technology in the social care sector by investigating phenomena found at the interface between ICTs and care work. The CARICT project has illustrated the diversity as well as complexity of this domain. Within the project they selected and analysed fifty two ICTbased initiatives for caregivers in Europe (Schmidt et al., 2011) and from the evidence gathered they concluded that ICT-based services empower both care recipients and carers and improve their quality of life at affordable costs and without the feared dehumanising effects (Carretero et al., 2012). Two inter-connected areas can be identified where the increased proximity of technology and care has advanced significantly: first telemedicine/telecare, and health monitoring systems and second assistive technologies. Telecare, understood as remote assistance enabled by digital technology, has already gained wide recognition in the professional care sector, although international comparative analyses indicate persisting economic as well as political limitations (Kubitschke and Cullen, 2010). The area of assistive technologies covers an extensive range of solutions from simple alarm buttons, vital signs monitoring and self-diagnosis devices to complex systems known as smart homes. As these technologies become more commonplace in care provision then increasing levels of digital competence are likely to be expected in the near future in the care workers and caregivers across Europe (cf. Hjalager 2009). 1 THE TEXT OF THIS CHAPTER IS ADAPTED FROM OUR CONFERENCE PAPER TO BE PRESENTED THE EDEN ANNUAL CONFERENCE IN OSLO IN JUNE 2013 (CF. VALENTA ET AL., 2013). 10

11 However, technically clear-cut and specific application scenarios such as telecare and assistive technologies are only one of the drivers towards an examination of the digital competences of care workers and care working sector. The research described here to inform the CARER+ digital competence framework for care workers is based on the assertion that being digitally competent transcends mere technical dexterity and cannot be reduced to instrumental knowledge and skills such as operation of specific software. Rather, digital competence is to be understood as part of the:...essential life skills and assets in the information society. Developing digital competence should be considered as a continuum from instrumental skills towards productive and strategic personal competence. Mastering basic tools and computer applications is only a first step towards advanced knowledge, skills and attitudes, (Ala-Mutka, 2011: p. 5). On one hand digital competence, as one of the key competences for lifelong learning (European Parliament and the Council, 2006), contributes to determining our overall capacity to engage with present-day social, cultural and economic settings. Yet, the theoretical notion of competence manifests itself in practice only through application in a specific context. Therefore, the central research question has been formulated as follows: How is the transversal or non-domain specific aspect of digital competence manifested, supplemented and modified through its contextualisation in care work? Our approach to the concept of competence and the underlying notion of learning outcomes is clarified below, before proceeding to the methodology for collecting empirical information on the components of digital competence in care work Competences and learning outcomes The adoption and implementation of a learning outcomes approach to educational interventions can be considered among the most significant developments in educational policy and practice worldwide in recent years. Within the framework of the European policies in education and lifelong learning, learning outcomes are understood as...statements of what a learner knows, understands and is able to do on completion of a learning process, which are defined in terms of knowledge, skills and competence, (European Parliament and the Council, 2008: p. 4). However the definition and in particular the related implementation mechanisms remain far from unchallenged. The literature in this domain covers a wealth of academic and practice-oriented debates on learning outcomes. Elaborating on these debates is beyond the scope of this Deliverable but by way of illustration it is enough to state that the main objections to the concept of learning outcomes have been towards the reductionist implications in the behaviouristic conviction that all learning outcomes can take form of observable performances (Cedefop, 2012; cf. also Lassnigg, 2012). This is related to another line of critique that points to the danger of confusing the sign (a learning outcome statement) and the signified (the reality of learning it described), that therefore creates the illusion that the sole act of describing learning 11

12 outcomes automatically implies their validity (cf. Souto-Otero 2012). The misappropriation of the use of learning outcomes as a self-sufficient managerial instrument has been well demonstrated (Hussey and Smith, 2002). These critiques have been reflected in changes to European policy documents where the previously unreflexive approach to learning outcomes prevalent in early EU policy documents (Cedefop, 2008) has been superseded by a more refined stance in later policy outputs: Contemporary accounts of learning outcomes emphasise their diversity and suggest that, where learning outcomes are tacit, context-bound or applied in combination with one another, then inferential rather than behaviouristic approaches will be more appropriate (...). Learning outcomes are no longer conceptualised as self-evident performances, (Cedefop, 2012: p. 33). Related to this understanding of learning outcomes is the question of competence which situates itself as a key concept informing the CARER+ conceptual background. Some educational and training discourses use the terms learning outcomes and competence interchangeably (Cedefop, 2012), yet a conceptual distinction between the two allows for more clarity as well as it brings about a sound analytical strategy: Competences usually refer to practices in the workplace and, by extension, to wider social and personal practices. Learning outcomes refer not directly to work practices but to competences. Accordingly, learning outcomes are validated by their connection to competences which are understood as part of the world of work (as their source),.. whereas learning outcomes are therefore part of the educational design. Thus, it is useful to distinguish: some systematic way of identifying competences and translating them into learning outcomes. (...) The conceptual separation of learning outcomes and competences allows us to see that learning outcomes can communicate between the status quo of competences in the world of work and competences (specific to individuals) that enter the employment market in the future, (Cedefop, 2012: p. 35). Rather than start at the level of inductively defining learning outcomes in terms of knowledge, skills and competence CARER+ chooses to start at the level of competence. This is deductively defined as a dialectics of knowledge, skills, attitudes and purposes, where broader competence areas derive from the socio-economic context and are translated into learning outcome examples. This approach has been inspired by the conceptual logic of the forthcoming European Digital Competence Framework, currently finalised by the European Commission Joint Research Centre, Institute for Prospective Technological Studies (Ferrari, 2012a; 2012b), which has served as a structural model for the CARER+ Digital Competence Framework for care workers Methodology To investigate the relevance of digital competences in the care sector, as well as to identify the digital knowledge and skills likely to emerge within care workers activities in the near future, four research methods were implemented: document analysis 12

13 expert focus groups semi-structured individual interviews with experts a questionnaire survey to care workers and caregivers. Nine project partners in seven European countries participated in the research. 3s Unternehmensberatung GmbH (Austria) as the work package leader, Arcola Research (United Kindgom), EOS Educating for an Open Society (Romania), Iperia L Institut and Fédération des Particuliers Employeurs de France (France), Istituto per la Ricerca Sociale (Italy), LIKTA - Latvijas Informacijas en Komunikacijas Tehnologijas Asociacija and LSA - Latvijas Samariesu Apvieniba (Latvia), and TELECENTRE Europe (Belgium). Focus groups and interviews with experts took place in all seven countries (AT, BE, FF, IT, LV, RO, and UK) in line with the research design 2, while the desk research and questionnaire survey were limited to countries where the pilot testing of CARER+ outcomes will take place in the next phase of the project (FR, IT, LV, RO) 3. PHASE 1: DESK RESEARCH DOCUMENT ANALYSIS The objective of this research activity was to identify and analyse accessible educational and occupational documentation in the care sector, examine how digital competence is reflected, and report examples of digital learning outcomes found. In particular, the following types of documents were consulted: Curricula of initial vocational training programmes for care workers; Curricula of continuing vocational training programmes for care workers; National Qualifications Frameworks / Systems / Registers; Qualification standards; Assessment standards; Europass Certificate Supplements; Occupational standards; Job descriptions and job advertisements. PHASE 2: EXPERT FOCUS GROUPS Within this phase of research, focus groups in all partner countries were organised, that brought together 5 to 10 national experts in various fields related to the project scope. In Phase 1 the outputs depended, in principle, on the quality of information available in external sources and thus turned out to be of miscellaneous relevance. But in Phase 2 the aim was to ensure that specificities identified within the scope of the CARER+ scope were addressed. In 2 ORIGINALLY, THE RESEARCH METHODOLOGY PROVIDED IN CARER+ DELIVERABLE 2.1 (VALENTA ET AL., 2012) FORESAW 8 COUNTRIES PARTICIPATING IN THE RESEARCH. THIS NUMBER WAS AMENDED TO 7 DUE TO THE SWEDISH PARTNER S EXIT FROM THE PROJECT. 3 AND SPAIN. THE SPANISH PARTNER, HOWEVER, REPLACED THE EXITING SWEDISH PARTNER ONLY AFTER THE RESEARCH ACTIVITIES WERE CONDUCTED. 13

14 other words, the focus groups were expected to provide information on topics of direct to CARER+ around the interface between care work and digital competence. For the objectives of the focus groups to be met, it was of great importance that the participants were selected according to the project rationale but also with regard to the diversity of views and fields of expertise. The participants in the expert focus groups thus included: leading personnel in care providing organisations, both public and private; leading personnel in charities, care worker associations and care recipients associations; academics and researchers in the field of socal care, ehealth, Ambient Assisted Living (AAL); medical and nursing professionals; experts in national as well as European policy of social cohesion, welfare and active ageing; entrepreneurs and technical experts in the field of assistive technologies; experts in digital literacy and e-learning. The three principle areas of inquiry discussed in each focus group were: What is the current situation? What digital skills do care workers currently need and utilise? To what extent is ICT relevant in the field? How can ICT be further used to support both care workers in their work and care recipients in their daily lives? What new digital skills will care workers need? What should be included in a carer s digital competence list? PHASE 3: SEMI-STRUCTURED EXPERT INTERVIEWS By interviewing selected experts individually, Phase 3 aimed to gain deeper insight in the research area, and to add more detail to information collected through Phases 1 and 2,. Each partner invited 5 to 10 experts for semi-structured interviews. The respondents may or may not have been members of the focus groups established in Phase 2, yet they were recruited from the same categories of respondents as in the case of focus groups. Three themes were addressed during each interview, with the following inquiry logic and elementary questions: Theme 1. Current experience with implementing digital competence and ICTs in care work: > 1a) In general, what do you think about the relationship between digital skills/ict and care work? > 1b) If you were to describe a care worker s typical day, how would the use of ICT occur in it? Theme 2. Care recipients needs: 14

15 > 2a) What, in your opinion, are the care recipients needs that could be met using digital technology? > 2b) How you think care receivers will react to services involving digital technology? Theme 3. Digital competence for care workers and caregivers: > 3a) Presently, how are digital competences incorporated in care workers qualifications? > 3b) Which digital competences would you name as substantial for care workers? > 3c) Which additional digital competences would you regard advantageous for care workers? PHASE 4: QUESTIONNAIRE AMONG CARE WORKERS AND CAREGIVERS While Phase 1 derived information from official documentation, and Phases 2 and 3 investigated expert opinion, Phase 4 complemented the research with information from practitioners, i.e. care workers and caregivers. This was done through a multiple choice questionnaire filled in by care workers and caregivers either in hard copy or via an online interface. The project partners were asked to collect 40 completed questionnaires in each of the four countries involved in this phase, thus arriving at a total of 160 questionnaires. This would then provide a pool of data on practitioner s current digital skills and related views and preferences for the next research steps.. For the sampling methodology, the selection of respondent samples was non-random in two ways. First, the partners did not build representative samples of the whole population but selected respondents from the narrowly defined groups of care workers. Secondly, these groups tended to vary according to their member features and average profile among countries, for example, the probability of a typical care worker having a migrant status was significantly higher in Italy than in Romania. Legal provisions regulating the conditions for access to care professions also differed from country to country, not to mention the unofficial caregivers who were often reluctant to be surveyed due to their unofficial economical or migrant status. Therefore it was impossible to define common sampling quotas for all countries involved in the survey. The partners were advised to apply their judgement based on knowledge of their national situation to build as representative samples as possible. Professional organisations, foundations, care associations and other stakeholders with good overview of the field were consulted regarding the profile of the respondent sample in each country. The questionnaire was divided into four sections: Pre-section. Category of respondent: > 4 questions on respondent s job, level of formal education, experience in care work, country of origin. Section A. Respondent s current level of digital competence: > 10 questions on (mostly instrumental) ICT competences; self-assessment on a scale from 1 to 10 15

16 Section B. Relevance of digital competence and technology in care work: > 7 statements assessed against a self-anchoring scale from not at all to very much so or its variants Section C. Assessment of clients needs: > 4 statements assessed against a self-anchoring scale from not at all to very much so or its variants 2.4. Key results and findings In this chapter we provide a consise overview of the key results and findings of the CARER+ research on ICT knowledge, skills and competences in the international care sector. Due to the comparatively large amount of data gathered, a full account of the qualitative and quantitative evidence collected by the CARER+ research is found in Annexes. The following table summarises the outputs delivered as compared to expected: Table 1 Research outputs Research phase 1:Document analysis Number of countries involved Outputs per country, planned minimum Outputs total, planned minimum Outputs total, delivered 4 not specified not specified 57 2: Focus groups : Interviews : Questionnaires The table shows that in research phases 2 and 3, where quantitative targets were set, the numbers of planned outputs were exceeded (rather significantly for interviews: 31,4% more interviews were conducted than planned in phase 3). In phase 4, 160 questionnaires were planned but only 156 collected. The difference was caused by a lower response rate in Italy where there are an above-average number of undeclared care workers active in a grey market and thus reluctant to get exposed by taking part in a survey. EVIDENCE QUESTIONNAIRE SURVEY TO CARE WORKERS AND CAREGIVERS: SELECTED The following tables demonstrate selected evidence provided by a quantitative analysis of the questionnaire survey conducted in four partner countries (Ziegler, 2012). Tables 2, 3 and 4 contain information on the sample, Tables 5, 6 and 7 show respondents answers to selected questions concerning their current digital competence and views on its future development. 16

17 Table 2 Number of care workers and caregivers surveyed in each country; absolute numbers France Italy Latvia Romania Total Table 3 Distribution of respondents according to the type of involvement in care work; % of total Freelance care Organised care Care worker-to-be Family member Other Total worker/caregiver worker/caregiver (currently in / relative (hired directly by (hired by an agency, training) client) social service, etc.) % Table 4 Distribution of respondents according to the length of experience in care work; % of total Less than 2 years 2 to 5 years 6 to 10 years More than 10 years Total % Table 5 How would you assess your overall digital competence? (1= no skills at all; 10= top expert) ; % of total n/a Total % Table 6 To perform your job well, the level of your digital competence is... ; % of total Not relevant at all Negligible Fairly important Very important Don t know Total % Table 7 Do you think your older clients would appreciate additional services supported by digital technology? ; % of total Not at all Unlikely Possibly Likely Very likely Don t know Total % EXPERT VIEWS ON DIGITAL COMPETENCE IN THE CARE SECTOR This section summarises key findings of the qualitative analysis of the information collected through expert focus groups and interviews. A cross-referential discoursive analysis of the reports from focus groups and individual interviews allowed for identification of several areas where recurrent views were expressed across all, or in some cases, most countries. The more frequently expressed opinions can be divided into three thematic areas: views on the changing attitudes of the care recipients towards ICTs; views on the ways care workers can support the care recipients in this process of digital emancipation; 17

18 views on how carers themselves can further utilise digital competence in various aspects of their work. The majority of experts agreed that notion of digital competence can already be seen as useful and needed in the social care sector, and that it will gain a more central position in care work in a near future. This will partially be due to rapid developments in ehealth, tele-care and assistive technologies that are being translated from cutting-edge experiments into commonplace practical solutions that are affordable to a growing number of care services as well as care recipients. As importantly, every-day digital technologies such as personal computers, tablets and smart phones are becoming more pervasive and entering the lives of the care recipients. The stereotype of older people opposed to digital developments and unwilling or afraid to engage in ICT-based services can no longer be taken for granted. A number of experts have acknowledged that recent experience shows that older people are increasingly open to digital technologies provided they are user-friendly and adjusted to specific user need. They are now more often losing their timidity and becoming willing to learn about the possibilities afforded by the use of ICTs. However, many experts warned against exaggerated digital optimism and indiscriminate futurism. In the area of telemedicine, traditional solutions such as alarm buttons or selfdiagnosis measurement devices are widely used by people in home care, but more sophisticated arrangements such as video monitoring and other features of smart homes cannot yet be seen as standard. With regard to more widely available technologies, several interviewees pointed out that non-smart phone and television remain by far the most often used digital devices in the lives of older people. According to the experts, this fact should be acknowledged and ways should be explored to capitalise on the care receivers familiarity with phone and television e.g. by extending TV functions to online connection or introducing to older people alternative ways of making phone calls via internet-based services such as Skype. The area most frequently raised was the potential for ICTs to improve the social aspects of the lives of care recipients. The majority of interviewees as well as focus group participants were convinced that online communication should be regarded as the primary benefit brought to home care recipients by digital technology. Easy messaging, video calls and chats can facilitate and intensify an older person s contact with his/her family and wider social circle. Online networks and communities can help an isolated person (re)establish relationships and get (re)involved in local affairs as well as remote ones. According to the experts interviewed, online interaction should no longer be considered dehumanising or inferior to real relationships. In their view, the avenues for online participation are now no longer cryptic codebased hideaways but allow for direct inter-personal contact, audio-visual communication, inclusiveness and productive togetherness. Yet there are risks with online participation and include the safety and privacy of the user. These are factors that older people might be particularly vulnerable to and this was often mentioned as one of the areas where the careworker can step in. When asked about the current average level of digital competence among care workers, most experts agreed that it is generally low and needs improvement. However, due to the heterogeneity of the target group it is difficult to draw universal conclusions. Qualified professional care workers are more likely to have a basic to average level of digital 18

19 competence than unofficial caregivers. Normally, qualified care workers have completed a certain level of formal education and be in official employment with a care organisation. This tends to involve systematic training and CPD as well as require day-to-day work with ICTs for the purposes of administration, planning and reporting of care work. Caregivers are often challenged by their lower social background, language barriers and lack of access to further learning. It was also reported that some caregivers are recruited from economic migrants coming from Eastern Europe, where they may have held qualified jobs and used ICT on a daily basis but chose to relocate and accept non-qualified jobs in Western Europe - in response to the difficult living conditions in their countries of origin. A good level of digital competence can be found among these caregivers (reported in Italy in particular). In conclusion, most experts agreed that further training in digital competence for care workers as well as caregivers is desirable, promising and appropriate with regard to future developments in the sector, and in society. In the view of the experts the role of the carer as a guide and mediator who facilitates the care recipient s gradual adoption of digital technology was central. The presumption here was that the care worker who becomes digitally competent will allow him/her to encourage the care recipient to explore the advantages of digital technology, and guide them through various aspects of its usage. Experts agreed that the care worker should not be expected to perform the role of a technician who would be responsible for setting up equipment or for repairing tasks but instead should mediate the client s dealing with services such as internet providers, equipment sellers and on on). With more advanced levels of digital competence, the care worker should be able to assess a care recipient s individual needs, interests and preferences and recommend corresponding digital services. A digitally competent care worker will also be able to help ensure client s security in digital environments. Often mentioned was the inter-personal merit of learning together, i.e. strengthening social bonds between the care worker and the care recipient through purposeful interaction in exploring digital technologies and services. Apart from applying digital competence in their work with care recipients, the care worker is expected to utilise technology in supplementary organisational and administrative tasks. According to the experts, there is great potential in the portable modern device such as smart phone and tablet. Because geographic mobility and time flexibility are among the key principles in care work, the technology that allows for mobile connectivity should be seen as highly adequate a work tool for care workers. Planning, tracking, recording and monitoring visits to clients through smart mobile devices in real time was seen by the experts as beneficial to both care workers and the care services that employ them. Another area where digital competence was reported as increasingly relevant was care administration and management. Many care services either use special software already or see the adoption of one as a necessary next step. The ability to engage in digital administration was also reported as a precondition for care workers career growth within their organisations. Finally, e-learning and peer communities were repeatedly mentioned as highly advantageous for care workers. Digital platforms for the exchange of professional experience can potentially help care workers quickly consult immediate problems with peers, as well as enhance their overall care work competence in the long term. Also, caregivers who tend to be more liable to social isolation (for example due to language or cultural barriers) can overcome 19

20 this predicament by joining a network of fellow caregivers or finding online new clients interested in their services. 20

21 TEXTUAL ANALYSIS TO IDENTIFY COMPETENCE CATEGORIES AND EXAMPLES OF LEARNING OUTCOMES ILLUSTRATION OF THE METHOD All narrative reports from research phases 1, 2 and 3 (competence documents, focus group reports, interview reports) were analysed using the methods of qualitatitve textual analysis and text-mining. The objective of this analytical exercise was twofold: to identify recurring categories, concepts and learning-outcome examples that would define the structural elements of the framework such as Competence Areas and Competences; to verify the structural elements defined in consultation with other sources (literature, other frameworks and initiatives) by mapping the research data on the framework s categories and concepts. The method is illustrated by the image on the next page. The screenshot depicts a randomly selected page from an authentic focus group report. 4 Specific formulations and quotations recorded by the focus group rapporteur have either informed the establishment of, or have been mapped on, the different Competence Areas and Competences in the CARER+ framework s coding system represented in the image by the coloured shapes (consult later chapters of this document for more information on the coding system). All narrative research outputs found in Annexes have been processed in this way: 4 THE PAGE COMES FROM THE FOCUS GROUP REPORT SUBMITTED BY THE AUSTRIAN PARTNER. SEE ANNEXES FOR COMPLETE REPORTS. 21

22 Image 1: Illustration of the textual analysis method / mapping on the framework s coding system (demonstrated on an authentic page from the Austrian focus group report, cf. Annexes). 22

23 3. Context analysis To map and analyze the conceptual and applied developments at the interface of digital technology and care work, a number of related literature items, projects, initiatives and structures were consulted (see section 3.1 below). Three major developments were identified as key sources of information for the CARER+ Digital Competence Framework, and examined more closely (section 3.2) List of relevant projects and initiatives consulted Title Website Rationale ICARE Project The ICARE project focuses on the adaptation of an already existing system of vocational qualifications in the field of personal care and social work in coherence with the ECVET framework, and on the testing and development of relevant tools for a steady application of ECVET principles and specifications. Journal of Medical Imaging and Health Informatics m/content/asp/jmihi/2012/ / Special Issue on Ubiquitous Computing in Healthcare Go-myLife Project Go-myLife is an Ambient Assisted Living project aiming to improve the quality of life for older people through the use of online social networks combined with mobile technologies. PRIMER-ICT Project The project aims to educate students primarily from health and ICT related fields who will in turn educate both older people and the multipliers (community nurses, nurses in senior homes, family members, volunteers from different sectors/ages). ICT & Ageing Users, Markets and Technologies CARICT: ICT-based solutions for caregivers hp?xml_id=1850 The ICT & Ageing Users, Markets and Technologies study was funded by the European Commission. The primary aim was to identify existing market barriers that hinder uptake of technologies for independent living and identify recommendations for action in order to address older peoples needs and market potentials. The main goal of CARICT was to investigate the potential impact of information and communication technologies (ICTs) on informal 23

24 The Potential of ICT to Support Domiciliary Care Cedefop Statistics and Indicators: ICT skill levels on the rise 4Leaf Clover Model for Senior Service Sector ipts.jrc.ec.europa.eu/publicati ons/pub.cfm?id= articles/20404.aspx htm?prj=3828#.uwguhfdim wc carers of older people living in the community (e.g. relatives and friends) as well as on paid assistants employed by private households. A series of country reports published by the EC Joint Research Centre. ICT skill indicators and related findings published by the European Centre for the Development of Vocational Training A Leonardo da Vinci innovative project aimed at: mapping the future senior service sector with focus on the expected challenges in recruitment and working schemes in year perspective (patterns of change); recommending changes in CVET patterns and training solutions which should meet theses challenges using LLL principles; developing concrete models which can be used by CVET provider Europe wide. Proper Chance Project The aim of the project is to support professional permeability and mobility for workers in the field of health and social care by promoting the use of ECVET to support transparency and recognition of learning outcomes and qualifications, including nonformal and informal learning. NoBoMa In the NoBoMa project the VQTS model is used for developing a Competence Matrix, Competence Profiles and a Future Competence Matrix by using new ideas, new methods and by adding future skill needs, in order to meet future challenges in the field of social care Major sources examined Three international frameworks representing three different approaches to digital competence architecture were analysed in order to discover how their logic and structural components can inform the design of the CARER+ Digital Competence Framework: The European Computer Driving Lincence (ECDL) The European e-competence Framework (e-cf) 24

25 The Framework for Developing and Understanding Digital Competence in Europe (DIGCOMP) Whereas the first two have been functioning as established mechanisms for some time now, the DIGCOMP study is being finalised parallel with this Deliverable. However, its interim proceedings allowed for the integration of its logic and conceptual background in the CARER+ analysis. In the following, the outcomes of the analysis are outlined. THE EUROPEAN COMPUTER DRIVING LICENCE (ECDL) ECDL (and its international variant ICDL) is a training and certification scheme offering a set of mechanisms and tools for everyone who whishes to become fully competent in the use of a computer and common applications. Each ECDL/ICDL module provides a practical programme of up-to-dat skills and knowledge areas which are validated by a test. 5 The ECDL approach to digital competence can be regarded as instrumental, practiceoriented and skills-based. Analysis of the ECDL Syllabus Version 5.0 (ECDL Foundation, 2007) shows that the concept of digital competence is understood within this scheme as the ability to demonstrate task-oriented knowledge and to deploy practical skills in performing specific actions with a computer or an application. The structure of the syllabus can be illustrated through the following diagram showing a selected line of hierarchy of categories and concepts applied: Image 2: Structure of ECDL (source: own analysis based on EDCL Foundation, 2007) 5 DISPLAYED

26 The lowest niveau of the above represented hieararchy are the Skill Items, i.e. detailed descriptions of practical skills to be demonstrated by a person in an ECDL test. Hence, it can be inferred that the ECDL framework is a rich repository of instrumental skills organised according to an elaborate logic of user tasks. As mentioned earlier in this report, however, a contemporary understanding of the concept of digital competence must reach beyond mere technical and instrumental dexterity to capture the competence in its comprehensiveness. Such approach can be partially identified within the following development. THE EUROPEAN E-COMPETENCE FRAMEWORK (E-CF) The European e-competence Framework (e-cf) has different application purposes than ECDL. While ECDL s rationale is to serve as a testing and certification scheme, ecf was created to provide a common, shared, European tool to support organizations and training institutions in recruitment, assessment, competence needs analysis, learning programmes, career path design and development, (Marinoni and Rogalla, 2010, p. 3). The primary users are thus ICT staff and their employers. On one hand, therefore, the focus on professional users of digital technology sets the actual contents of the e-cf framework beyond the needs of CARER+ that remain at the level of non-professional, general digital user. On the other hand, the e-cf was among the first to introduce the approach to digital competence that starts from abstractly defined areas of competence that represent broader cognitive concepts, to proceed only lower in the structure to specific instances of these abstract concepts manifested through examples of knowledge and skills. The general logic of the e-cf shall be illustrated by the following diagram showing a selected line of hierarchy traced within the framework: Image 3: Structure of e-cf (source: own analysis based on Marinoni and Rogalla, 2010) 26

27 The framework is organised around four dimensions: ecompetence Areas; ecompetences; Proficiency Level Specifications; and Knowledge and Skills examples. The key notion here is the dimension of ecompetence Areas that are not ICT-specific activities but rather abstract concepts referring to five cognitive capabilities: plan; build; run; enable; and manage. Defining such broad competence areas allowed the e-cf to accommodate, on lower niveaus of the structure, transversal competences that are necessary in performing ICT tasks but cannot be inferred directly from digital technology alone. Another important aspect introduced by the e-cf is the conceptualisation of knowledgeand-skill definitions as mere examples rather than constitutive elements of the competence. As discussed above, the earlier approach to defining competences through discrete and would-be-exhaustive packages of knowledge and skill items necessarily implies reductionism and limits the applicability of the outcome in changing contexts. Rapid pace of development and change being a basic characteristic of digital technology, it can be held that a more flexible, liberal and modifiable way of difining competence is the only sustainable methodological strategy. This can be achieved, as the e-cf proposes, by defining the dimension of knowledge and skills as an open set of changeable examples rather than a discrete set of immovable structural entities. Nevertheless, despite the important steps towards a more comprehensive and flexible interpretation of digital competence, at the level of contents the e-cf follows the needs of its target group: ICT professionals. From here, therefore, the CARER+ analysis moved on and turned to a recent European development that builds on the conceptual achievements of the e-cf but focuses on general public: the DIGCOMP initiative. DIGCOMP: A FRAMEWORK FOR DEVELOPING AND UNDERSTANDING DIGITAL COMPETENCE IN EUROPE The DIGCOMP study has been realised by the European Commission Joint Research Centre, Institute for Prospective Technological Studies (IPTS). The work is still in progress, and the CARER+ analysis is based on the outcomes so far available (Ala-Mutka, 2011; Ferrari, 2012; and Ferrari, forthcoming). However, the pre-final outputs provided by IPTS for the stakeholder consultation process (involving CARER+ experts) have delivered sufficient basis for integrating the main characteristics of DIGCOMP into our analysis. Also, the policy background of DIGCOMP indicates that this development has considerable potential to become, in a foreseeable future, Europe s reference mechanism in the area of digital competence. Therefore, if CARER+ is to ensure relevance and compatibility with key European policy developments, the DIGCOMP initiative is a primary source to seek synergies with. DIGCOMP adopts a broad definition of digital competence understood as interplay between instrumental/technical knowledge and skills, transversal/soft knowledge and skills, and personal attitudes. It builds on the structure introduced by the e-cf and starts by defining general competence areas that are populated by particular competences which in turn are illustrated through examples of knowledge, skills and attitudes. To the four dimensions defined by e-cf, DIGCOM adds a fifth dimension: Application Purpose. To approximate the five dimensions of DIGCOMP, the following diagram can be used illustrating on a randomly selected competence the structural components of the system: 27

28 Image 4: Structure of DIGCOMP (source: own analysis based on Ferrari, forthcoming) The DIGCOMP framework distinguishes 5 competence areas: Information; Communication; Content creation; Safety; and Problem solving. Within these areas, 23 competences are defined altogether. As the competence areas, the competences too remain at a comparatively abstract and/or broad level. The framework features competences with titles such as Interacting through technologies which would comprise all kinds of digital communication and the variety of related skills from using to microblogging; or Developing content that can refer to diverse skills from using a word processor to write simple texts to creating complex multimedia presentations. The advantage of this approach is that more generally/abstractly defined categories allow for accommodating new developments in digital technology as well as non-technical abilities, such as critical evaluation of information or proactiveness and responsibility in online interactions, that exceed specific ICT instrumental skills but are preconditions for authentic digital competence required by contemporary digital environments. The authors of the DIGCOMP concept have foreseen that their general framework will serve as a point of departure, a component, and/or a basic organising principle for creating more context-specific frameworks according to particular needs and purposes. Hence, the next chapter outlines the logic of the CARER+ Digital Comptence Framework design. 28

29 4. Logic and design Based on the qualitative and quantitative information collected by the CARER+ research, and on the context analysis of related frameworks and developments, the CARER+ Digital Competence Framework has been designed around the following structural dimensions (with indication in brackets of the respective number of elements present in each dimension): Dimension 1: Competence Domains (3) Dimension 2: Competence Areas (12) Dimension 3: Competences (48) Dimension 4: Application Levels (2) Dimension 5: Examples of Learning Outcomes (unlimited) Competence Domains and Competence Areas (Dimensions 1 and 2) Domain A: General digital competence Domain B: Enabling digital competence in social care work Domain C: Occupation-specific and advanced digital competence in care work DOMAIN A: GENERAL DIGITAL COMPETENCE Domain A draws on the above discussed DIGCOMP framework and contains Competence areas and Competences focused on general digital competence, i.e. instances of digital literacy applied by a common user of ICTs. This Domain represents the non-sectoral baseline of the framework. The competences contained are therefore not care-specific but aim at equipping care workers and caregivers with a reference for acquiring general digital knowledge, skills and attitudes as defined by DIGCOMP. The 19 single Competences of this Domain are grouped into the following 4 Competence Areas: 6 Information Communication Content creation Safety To observe the compatibility and correspondence of the Carer+ DCF with the state-ofthe-art European developments, the DIGCOMP framework was used as the main source of structure and categorisation of this Domain. Also, the titles of competences and some of the 6 THE ORIGINAL DIGCOMP FRAMEWORK CONTAINS 5 COMPETENCE AREAS WITH A TOTAL OF 23 COMPETENCES. FOR THE PURPOSES OF THE CARER+ FRAMEWROK, THE FIFTH DIGCOMP AREA, PROBLEM SOLVING, HAS BEEN MODIFIED AND TRASFERRED INTO DOMAIN B. 29

30 examples of learning outcomes were adopted from DIGCOMP (in the User Application Level mostly). More learning outcomes were defined for the Mentor/Guide Application Level. The adaptation of DIGCOMP by other initiatives has been explicitly encouraged by its authors (Cf. Ferrari, forthcoming) as the framework has the ambition to become a European-level reference framework for digital competence. Carer+ has followed the invitation of the authors of DIGCOMP to use, adapt and enlarge the general framework in more specific contexts. DOMAIN B: ENABLING DIGITAL COMPETENCE IN SOCIAL CARE WORK Domain B represents a component of the framework that addresses the specifics of applying digital competence in the social care sector. Responding to the identification of obstacles such as low acceptance of digital technology among both care workers and care recipients, and the social and psychological needs specific for the context of social care work, this Domain contains 4 Competence Areas comprising 13 single Competences that can be regarded as meta-competences to enable and facilitate the very possibility of digital competence in the sector, the acceptance of it by all parties, and its sustainability over time. Thus, non-technical, interpersonal, soft, mediation-oriented and transversal competence elements are brought into the context of applied digital competence through this Domain. The Competence Areas in Domain B are: Acceptance Adaptation Progression Support WORK DOMAIN C: OCCUPATION-SPECIFIC AND ADVANCED DIGITAL COMPETENCE IN CARE Domain C is designed to accommodate the aspects of care workers digital competence that reflect technologies and processes specific for the care sector (such as e.g. ehealth, Ambient Assisted Living technologies), or the aspects that contribute to the employability and professional development of care workers (e.g. working with systems for digital administration in care work). Mostly hard skills, technology-specific competences and applied scenarios are thus reflected in the 16 single Competences of Domain C, grouped in the following 4 Competence Areas: Assistive technologies ehealth Professional development Administration and management The competences contained in different Domains are not to be understood as totally independent of each other but rather as mutually supportive, complementary and interactive. Learning outcomes that are characteristic for a given competence can function as precondition 30

31 of, supplement to, as well as result of another competence. This will allow for creative and user-specific utilisation of the framework, e.g. for creating tailored learning architecture and programmes by combining selected elements of the framework rather than following its structure schematically. Also, different learing pathways for learners at different levels of digital literacy can be designed due to the open nature of the framework. 31

32 The CARER+ Digital Competence Framework (DCF) can be illustrated by the following diagram, where the central circle represents the three Competence Domains; the square elements represent the Competence Areas belonging to each Domain; and the numeric circles express the number of Competences in each Domain. Image 5: High-level structure of CARER+ DCF Competences and Application Levels (Dimensions 3 and 4) As discussed above, the framework has three Domains in Dimension 1 divided into 12 Competence Areas in Dimension 2. Each Competence Area, then, is further divided into a number of single Competences in Dimension 3. Altogether, the framework has 48 single Competences. Each Competence is defined by the following aspects: numeric code indicating the Competence s position within the framework; title of the Competence; description of the Competence representing its main contents, and formulated as a series of sentences with gerund verb forms and divided by semi-colons. This is a general description of the competence where the order of elements represented by consecutive verb-object constructions may follow a progress logic from less to more complex, as well as a temporal logic illustrating the development of the 32

33 competence in time. Most Competences have two Application Levels (Dimension 4) in order to address the need of distinguishing two different modes of care workers and caregivers application of digital competence: User Guide/Mentor USER The User Application Level refers to the development of the care workers own digital knowledge, skills and attitudes, building his/her own digital literacy, and performing all digitalcompetence-related work tasks that do not comprise direct interaction with care recipients (but can be, and often are, either preparation or conditional for the work with care recipients). GUIDE/MENTOR The Application Level Guide/Mentor builds on the competence contained in the User level, and brings it forward into the context of interaction between care workers and care recipients. This Application Level thus mainly refers to care workers abilities to mediate digital competence to care recipients, to assist them in adopting it, and to facilitate care recipients usage of, and/or benefiting from, digital technologies and solutions. It is important to note that the rationale of the two Application Levels differs in the three different Competence Domains: Domain A is about general digital competence and common user skills. Therefore, the User level is essential in this Domain, whereas the Guide/Mentor level mostly consists in care workers mediating the User knowledge, skills and attitudes to the care recipients. Domain B addresses making digital competence possible in care work and sustainable in the lives of the care recipients. Therefore the User level here refers to care workers own acceptance of, and dealing with, digital technology. The Guide/Mentor level refers to addressing the challenges the obstacles on the side of care recipients, and ensuring their relevant and sustainable use of digital technologies. Domain C addresses the digital technologies specific for the care sector, and the employability and professionalisation of carers. Some of the Competences therein allow for both Application Levels. Some, however, can be only applied in the User mode, and some are only applicable in the Guide/Mentor mode. 33

34 Examples of Learning Outcomes (Dimension 5) The fifth dimension of the framework is represented by Examples of Learning Outcomes. Normally, these items are described for both Application Levels of a Competence; in the exceptional cases where only one Level is described through Learning Outcomes, the other Level is not applicable for that Compentence. As discussed above, these items are not to be understood as constitutive must-haves of the Competence but mere examples of how the competence can manifest itself through observable instances of a person s: Knowledge Skills Attitudes Each learning-outcome item is formulated in the following pattern: He/She is able to...<infinitive action verb> + <object construction> + <context construction>. Knowledge items normally refer to what a person is able to understand, explain, define, describe, distinguish, or exemplify. Sometimes knowledge items may also refer to intellectual actions such as to identify, analyse, or evaluate, even though these action verbs can also be used to express skills. Skill items refer to any acts a person is able to perform. These can include simple instrumental actions usually expressed by verbs such as to use, make, send, edit, modify. However, skill items can also represent more complex acts expressed by verbs such as support, protect, mediate, assit, or plan. Attitudes items refer to values, motivations, personal characteristics or ethical considerations that complement an individual s knowledge and skills and enable a full manifestation of the competence complex. These can be expressed through verbs such as to demonstrate, cultivate, promote, prioritise, observe, consider, maintain, and many others. The next chapter introduces the contents of the CARER+ Digital Competence Framework. First, a 3-dimensional display is given to provide a compact overview of the framework up to the level of Competences and their basic descriptions. Secondly, a 5- dimensional display is provided to introduce each Competence separately through a competence card containing also the two Application Levels and their Examples of Learning Outcomes. 34

35 5. The CARER+ Digital Competence Framework 3-dimensional display: X: COMPENTECE DOMAIN 0 Competence area 0.0 Competence title Competence description 35

36 Domain A: General digital competence (DIGCOMP adapted 7 ) 1 Information 1.1 Browsing, searching, & filtering information Accessing and searching for online information; finding relevant information; selecting resources effectively; creating personal information strategies. 1.2 Expressing information needs Understanding when information is needed and what type of information will fill a knowledge gap; articulating information needs in efficient way. 1.3 Evaluating information Making sure that the information fulfils the needs; gathering, processing, understanding and critically evaluating information. 1.4 Storing and retrieving Manipulating and storing information and content for easier retrieval; organising information and data. 2 Communication 2.1 Interacting through technologies Interacting through digital devices and applications; understanding how digital communication is distributed, displayed and managed; understanding appropriate ways of communicating through digital means; referring to different communication formats; adapting communication modes and strategies to specific audiences. 2.2 Sharing information and content Communicating with others the location and content of information found; sharing knowledge, content and resources; acting as an intermediary; spreading news, content and resources; applying citation practices and integrating new information into existing bodies of knowledge. 2.3 Engaging in online citizenship Participating in society through online engagement; seeking opportunities for self-development and empowerment in using technologies and digital environments; being aware of the potential of technologies for citizen participation. 2.4 Collaborating through digital technologies Using technologies and media for team work, collaborative processes and co-construction of digital content and resources. 2.5 Netiquette Knowing behavioral norms in online/virtual interactions; understanding cultural diversity aspects; protecting self and others from possible online dangers; developing active strategies to identify bad behaviour. 2.6 Managing digital identity Creating, adapting and managing one or multiple digital identities; protecting one's online reputation; 7 FOR SPECIFICS ON THE ADAPTATION OF DIGCOMP, AND FOR REFERENCES, CONSULT CHAPTERS 3 AND 4 ABOVE IN THIS DOCUMENT. 36

37 dealing with the data that one produces through several accounts and applications. 3 Content creation 3.1 Developing content Creating content in different formats; editing and improving content that one has created or that others have created. 3.2 Integrating and re-elaborating Modifying, refining, and combining existing resources to create new, original and relevant content and knowledge. 3.3 Copyright and licenses Understanding how copyright and licenses apply to information and content. 3.4 Producing multimedia and creative outputs Improving and innovating with ICT; actively participating in collaborative digital and multimedia production; expressing self creatively through digital media and technologies; creating knowledge with the support of technologies. 3.5 Programming Programming applications, software, devices; understanding the principles of programming; understanding what is behind programmes. 4 Safety 4.1 Protecting devices Protecting own devices and understanding related risks and threats; applying safety and security measures. 4.2 Protecting data and digital identity Understanding common terms of service; actively protecting own data; respecting other people's privacy; protecting self from online fraud, threats and cyberbullying. 4.3 Protecting health Avoiding health-risks related with the use of technology in terms of threats to physical and psychological well-being. 4.4 Protecting the environment Being aware of the impact of ICT on the environment; observing principles of efficiency and effectiveness. 37

38 Domain B: Enabling digital competence in social care work 5 Acceptance 5.1 Role of digital competence in care work Understanding the role of digital competence in care work; understanding how different kinds of digital technology can support care workers in their profession as well as care recipients in their daily lives; realising the benefits and challenges of implementing ICT in social care. 5.2 Inception and promotion Bringing digital competence and technology into own work practices; clarifying the advantages of digital technology to care recipients; introducing various types and possibilities of digital activity to care recipients; inspiring interest in ICT. 5.3 Encouragement and confidence building Overcoming psychological obstacles to the implementation of digital technology in care work such as the fear and mistrust of technology, low self-esteem and lack of interest; encouraging care recipients to gradually discover ICT-based activities; building confidence. 5.4 Sustainability Ensuring user-friendliness and adequacy of digital technology used by the care recipient; avoiding overcomplexity; observing sustainable user development; preventing discouragement and loss of interest. 6 Adaptation 6.1 Identification of digital needs Identifying own as well as care recipients' needs that can be addressed by digital technology; inspecting own as well as care recipients' daily practices, routines, interests and wishes and determining where 6.2 Identification of digital responses to needs digital technology can provide more effectiveness, efficiency and comfort. Identifying, based on own and care recipients' needs, appropriate digital solutions, strategies and activities; matching areas of need with available solutions; evaluating solutions and selecting ones best fitting particular situation's/person's context. 6.3 Tolerance and patience Communicating digital technology to care recipients in appropriate manner; adjusting the pace of learning to individual capacities and objective setbacks; dealing with failure and finding alternative solutions; promoting cooperative optimism; maintaining realism in expectations. 6.4 Variability, creativity and resourcefulness Supporting variability in digital technologies used and activities carried out; helping care recipients discover the creativity and multi-dimensionality of digital environments; preventing stereotypisation and boredom; providing orientation and guidance; helping with systematisation. 38

39 7 Progression 7.1 Learning together Strengthening the social bond between care worker and care recipient through the process of discovering digital technology together; balancing the role of guide with that of peer learner; identifying areas of common interest; promoting reciprocity, openness and cooperation; preserving mutual trust. 7.2 Evaluation of progress Setting learning targets; observing own and care recipients' advancements in digital competence; verifying acquisition of specific knowledge and skills; mapping the progress on competence frameworks and individual plans. 7.3 Feedback and modification Reflecting with care recipients regularly the advantages and challenges brought in their lives by digital technology; addressing obstacles; giving constructive and sensitive feedback; acknowledging achievements; modifying care recipients' digital user strategies and learning plans where appropriate. 8 Support 8.1 Guidance and mentoring Guiding care recipients through all stages of acquisition of digital competence according to individual needs and capabilities; mentoring and consulting; building on achievements and addressing challenges; responding to both explicit and tacit needs of assistance; promoting care recipients' autonomy and active 8.2 Technical, instrumental and organizational assistance approach. Performing basic technical operations; setting-up and launching standard equipment and applications; solving non-complex technical problems; trouble shooting; arranging for expert assistance in more complex problems; assisting care recipients in dealing with service providers and other external stakeholders. 39

40 Domain C: Occupation-specific and advanced digital competence in care work 9 Assistive technologies 9.1 Alarms and emergency aids Helping care recipients understand, install and use alarms and emergency aids; explaining to care recipients the purposes and operation scenarios of such devices; ensuring constant functionality of alarms; observing own reachability by remote emergencies; responding to emergencies and organising 9.2 Time organization and daily activities assistance due measures; dealing with accidental and panic-driven alarms. Familiarising with various digital solutions for the organisation of time and planning of daily activities;, utilising such means in the organisation of own work in relation to scheduling client visits or coordinating activities with other care workers;, assisting care recipients in utilising time organisers and memory aids, especially in relation to scheduling medical and care visits, medication reminders, planning and reminders of other daily personal and social activities. 9.3 Impairment aids and corrections Achieving an understanding of various technology-based impairment aids and corrections such as electronic hearing aids, optical aids, electronic voice assistants, orientation and mobility aids, etc., providing assistance to care recipients in induction, adjustment, use and maintenance of such devices, mediating expert assistance and service where appropriate. 9.4 Mobile smart objects and devices Understanding and using, for care purposes, mobile smart objects and devices such as smart phones, tablets, smart aids; assisting clients in introduction, set-up, use and maintenance of smart objects and devices; updating smart contents and applications; ensuring inter-operability with other digital technology; 9.5 Ambient Assisted Living and smart homes configuring smart objects' functions in accord with care recipients' individual needs and circumstances. Understanding the basics of the concept of care-based smart homes and other complex systems in the field of Ambient Assisted Living; pro-actively exploring innovations in the area; participating in practical implementation of related technologies; assisting care recipients interested in finding out more about smart homes and other complex systems. 40

41 10 ehealth 10.1 Vital sign monitoring, self-diagnosis and treatment systems Helping care recipients understand, set-up, use and maintain vital sign monitoring and self-diagnosis systems such as digital blood pressure measures, cardio-monitoring devices, diabetic diagnostical devices, urine self-test devices, etc.; assisting care recipients in reading, interpreting and recording results of measurements; ensuring correct operation of devices and validity of measurement data Telemedicine and telecare Understanding the concept of remote care and monitoring systems; understanding main technologies in the area; participating in remote monitoring of care recipients; dealing with requests for remote assistance; consulting care recipients via phone, skype and other communication technologies; observing 10.3 Digital support to physical activation and rehabilitation a balance between remote and personal care; observing the ethical dimension of telecare. Supporting care recipients' physical activation and rehabilitation through digital technology such as exercise aids, activity planners, tailored fitness programmes, etc.; preventing non-activity by complementing physically passive digital activities with active ones according to individual care recipient's 10.4 Digital recording and processing of health data possibilities and conditions. Monitoring digitally generated data on care recipients' health; using digital technology to record, store, systematise, analyse and process the data in cooperation with care services and medical professionals. 11 Professional development 11.1 Digital permanency and updating Keeping up with developments in digital technology in general as well as its implementation in care sector; exploring new and alternative solutions to care-related problems; planning own progress in digital competence according to competence frameworks and maps E-learning Improving own professional competences in care work by engaging in various kinds of e-learning activities;, finding open source learning resources and pathways;, organising own e-learning activities 11.3 Peer learning and exchange of good practices through online courses and programmes;, self-assessing learning results via evaluation exercises. Engaging in peer communities of care workers and caregivers; participating actively in the exchange of good practices; publishing and consulting online examples from own work and from the work of others; identifying local as well as remote care work groups and associations and contributing to their activities; coordinating with peer care workers the services provided to common or related care recipients Specialisation and certification Identifying specific areas of digital competence to establish the ones in which one is particularly interested;, pursuing improvement in such areas;, working towards specialisation and acquisition of expert 41

42 knowledge and skills;, understanding the purpose of certification;, validating one's learning outcomes through certificates, diplomas and other means of formal recognition. 12 Administration and management 12.1 Mobile administration of field work Using mobile digital devices to administer care work performed; monitoring own field work with positioning equipment; tracking through mobile devices the places visited and recording the activities carried out; ensuring flexible reactions and real-time response to care recipients' needs as well as to instructions from care service organisations Planning, monitoring, reporting Using digital devices and appropriate software to independently plan, monitor and report care activities; 12.3 Digital management of service in care organisation using care organisations' systems dedicated to planning, monitoring and reporting care work. Using care organisations' systems for managing care workers;, participating in coordination and monitoring of work of others through digital technologies;, undertaking supervision and leading roles in care organisations through digital means. 42

43 5-dimensional display: Competence domain Competence area Competence title Competence description X Application level User Guide/Mentor He/She is able to... Knowledge examples Skills examples Attitudes examples

44 Competence domain Competence area Competence title Competence description A General digital competence 1 Information 1.1 Browsing, searching, & filtering information Accessing and searching for online information; finding relevant information; selecting resources effectively; creating personal information strategies. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - understand how information is generated, managed and made - understand how care recipients face-to-face modes of inquiry available differ from digital ones - understand which search engines or databases best answer to - distinguish search engines and strategies most appropriate for his/her own information needs care recipients - understand how information can be found in different devices/media - adjust searches according to results - mediate the User skills to care recipients - use filters and agents - support care recipients in adopting the User skills - use search words that limit the number of hits - demonstrate proactive attitude towards looking for information - encourage care recipients curiosity and willingness to look for - be motivated to seek information for different aspects of life information 44

45 Competence domain Competence area Competence title Competence description A General digital competence 1 Information 1.2 Expressing information needs Understanding when information is needed and what type of information will fill a knowledge gap; articulating information needs in efficient way. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - evaluate own information needs - evaluate care recipients information needs - understand how information is made available online - define specifics of care recipients information needs - understand the difference between data and information - understand how data is structured in a digital environment - adjust searches according to specific needs - mediate the User skills to care recipients - identify information gaps - support care recipients in adopting the User skills - follow information flows across different sources, devices or media - realise that information is needed to solve problems in different - be reflective about care recipients information needs contexts - be reflective about own information needs 45

46 Competence domain Competence area Competence title Competence description A General digital competence 1 Information 1.3 Evaluating information Making sure that the information fulfils the needs; gathering, processing, understanding and critically evaluating information. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - understand that information sources need to be cross-checked - describe how non-critical adoption of information found online - analyse retrieved information can imperil care recipients - evaluate media content - give examples of reliable information sources relevant for care recipients - judge the validity of content found on the internet or the media - mediate the User skills to care recipients - interpret information - support care recipients in adopting the User skills - transform information into knowledge - assess the usefulness, timeliness, accuracy and integrity of information - compare, contrast and integrate information from different sources - be critical about information found - protect care recipients from perils related to unreliable or biased - be aware that search engine mechanisms and algorithms are information not necessarily neutral in displaying information 46

47 Competence domain Competence area Competence title Competence description A General digital competence 1 Information 1.4 Storing and retrieving Manipulating and storing information and content for easier retrieval; organising information and data. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - understand the purpose of information storing and back-up - identify care recipients preferred storage options - describe different storage options, devices, services, and media - evaluate care recipients technical possibilities for storage and - realise benefits and shortcomings of online and local storage retrieval of information and content - structure and classify information and content - mediate the User skills to care recipients - organise information and content - support care recipients in adopting the User skills - select appropriate ways of storing information according to context - download/upload information and content - use information management services, software, applications - retrieve and access previously stored information and content - acknowledge the importance of an intutive and pragmatic - promote the advantages of digital memory storage and its storage system/method benefits to care recipients - realise the consequences of storing information and content as - observe care recipients privacy and safety when assisting in private/public storing and retrieving their information and content 47

48 Competence domain Competence area Competence title Competence description A General digital competence 2 Communication 2.1 Interacting through technologies Interacting through digital devices and applications; understanding how digital communication is distributed, displayed and managed; understanding appropriate ways of communicating through digital means; referring to different communication formats; adapting communication modes and strategies to specific audiences. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - describe different digital communication means (e.g. , chat and videoconference, mobile messaging) recipients (e.g. diminishing solitude, re-establishing relationships, etc) - understand how communication generally benefits the lives of care - define the benefits and limitations of different means of digital - propose strategies to introduce digital communication to care recipients communication - select appropriate means of digital communication according to context - send , SMS, chat message - mediate the User skills to care recipients - find and contact people online - support care recipients in adopting the User skills - edit information in order to communicate it through several means - tailor communication according to audience - filter and organise incoming communication (e.g. organise s in folders, follow blogs and websites) - be confident and comfortable in communicating and expressing him/herself - balance non-digital and digital communication in care recipients lives through digital means - encourage care recipients interaction with family, friends and peers through - observe the risks linked with online communication with unknown people digital technology 48

49 Competence domain Competence area Competence title Competence description A General digital competence 2 Communication 2.2 Sharing information and content Communicating with others the location and content of information found; sharing knowledge, content and resources; acting as an intermediary; spreading news, content and resources; applying citation practices and integrating new information into existing bodies of knowledge. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - decide which content/knowledge/resources can be shared - understand positive effects of exchange of - judge the value of resources shared content/knowledge/resources by care recipients - distinguish types of audiences to share resources with - give examples of types of content care recipients can share - give examples of audiences for care recipients sharing - share content found online (e.g. share video in social networking - mediate the User skills to care recipients site) - support care recipients in adopting the User skills - use online environments to promote results of own activity - check property rights of content shared - be proactive in sharing content/knowledge/resources - observe care recipients privacy and safety when assisting in - observe benefits, risks and limits of sharing sharing their information and content - observe copyright issues - ensure that care recipients keep overview of their sharing activities 49

50 Competence domain Competence area Competence title Competence description A General digital competence 2 Communication 2.3 Engaging in online citizenship Participating in society through online engagement; seeking opportunities for self-development and empowerment in using technologies and digital environments; being aware of the potential of technologies for citizen participation. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - understand the participatory and engagement possibilities - evaluate care recipients level of engagement in various brought by digital technology networks, local communities, civic life and interest circles - understand that technology can be used for engagement in civic - explain how engagement and participation can benefit care and democratic actions recipients lives - give examples of different forms of public/civic participation - give examples of social media and online participation through digital means opportunities for care recipients - find online networks, communities and social media - mediate the User skills to care recipients corresponding to own interests and needs - support care recipients in adopting the User skills - access relevant networks and communities actively - value the benefits of online participation and networking - encourage care recipients to become active and participate in - maintain watchful attitude towards different social media public/local/interest-related affairs functionalities - promote diversity of interests and opportunities to engage in communities with others 50

51 Competence domain Competence area Competence title Competence description A General digital competence 2 Communication 2.4 Collaborating through digital channels Using technologies and media for team work, collaborative processes and co-construction of digital content and resources. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - understand how collaborative processes facilitate content - describe how care workers can benefit from digital collaboration creation with each other - distinguish when content creation can benefit from collaborative - describe what advantages digital collaboration among care processes and when not workers can bring to care recipients - understand different roles needed in diverse forms of online - give examples of concrete digital collaboration activities in care collaboration - use collaborative features of software packages and web-based - mediate the User skills to care recipients and fellow care collaborative services (e.g. Word document track changes, workers comments, tags, wikis) - support care recipients and fellow care workers in adopting the - give and receive feedback User skills - work at a distance with others - demonstrate willingness to collaborate with others - recognise the potential of working collaboratively with other care - function as part of a team workers - seek new forms of collaboration not necessarily based on previous face-to-face engagement 51

52 Competence domain Competence area Competence title Competence description A General digital competence 2 Communication 2.5 Netiquette Knowing behavioural norms in online/virtual interactions; understanding cultural diversity aspects; protecting self and others from possible online dangers; developing active strategies to identify bad behaviour. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples - describe examples of correct and wrong conduct in digital interactions - understand consequences of own behaviour in digital environments - understand ethical issues in digital media such as improper websites and cyberbullying - protect him/herself and others from online threats - ban/report abuse and threats - develop strategies for handling cyberbullying and inappropriate conduct - consider ethical principles of use and publication of information - demonstrate flexibility and sensitiveness for different communication cultures He/She is able to... - identify ethical issues and threats specifically concerning care recipients in digital interactions (e.g. cyberbullying, online fraud, misconduct, hoax, misuse of personal data, disturbing or improper content) - mediate the User skills to care recipients - support care recipients in adopting the User skills - prioritise protection of care recipients over functional demands of technologies, applications and online environments 52

53 Competence domain Competence area Competence title Competence description A General digital competence 2 Communication 2.6 Managing digital identity Creating, adapting and managing one or multiple digital identities; protecting one's online reputation; dealing with the data that one produces through several accounts and applications. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - define the benefits of having one or more digital identities - explain to care recipients the concept of digital identity - understand the interlinks between the online and offline world - familiarise care recipients with elementary principles for creating - understand that several actors can positively or negatively and managing digital identities contribute to constructing his/her digital identity - describe specifics of care recipients dealing with digital identities, footprint, disclosure of information - construct profiles that benefit his/her needs - mediate the User skills to care recipients - track own digital footprint - support care recipients in adopting the User skills - protect him/herself and others from online threats to their e- reputation - realise the benefits and risks related to online identity exposure - protect care recipients from risks related to their online exposure - be willing to disclose certain type of information about self - encourage care recipients active and safe building of their - consider multiple ways of expressing his/her own personality digital identities through digital means 53

54 Competence domain Competence area Competence title Competence description A General digital competence 3 Content creation 3.1 Developing content Creating content in different formats; editing and improving content that one has created or that others have created. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - understand how different content is created - define the types of content care recipients can create - distinguish which software/application fits best the content - identify easy-to-use content development packages for care he/she wants to create recipients to create and edit texts, tables, images - use basic packages to create content in different forms (text, - mediate the User skills to care recipients spreadsheets, audio, numeric, images) - support care recipients in adopting the User skills - edit content created by him/herself or by others - create knowledge representations using digital media - be innovative towards commonly used forms of content creation - support creativity of care recipients - explore new ways and formats - encourage care recipients transition from non-digital to digital creation fo content - observe user friendliness and intuitiveness of content development tools used by care recipients 54

55 Competence domain Competence area Competence title Competence description A General digital competence 3 Content creation 3.2 Integrating and re-elaborating Modifying, refining, and combining existing resources to create new, original and relevant content and knowledge. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - understand that resources can be built from diverse and nonsequential - identify in care recipients digital activity the possibilities for information sources creative modification and combining of sources - distinguish different databases and resources that can be - give examples of open-source repositories and databases with remixed and re-used content relevant for care recipients - use edit functions to modify content in basic ways - mediate the User skills to care recipients - remix different existing content into something new - support care recipients in adopting the User skills - exploit digital repositories (e.g. Open Educational Resources) - use appropriate licenses for authoring and sharing content - be critical in the selection of content and resources to be reelaborated - support creativity of care recipients - cultivate care recipients independence and proactivity in their - assess and appreciate the work of others work with content 55

56 Competence domain Competence area Competence title Competence description A General digital competence 3 Content creation 3.3 Copyright and licenses Understanding how copyright and licenses apply to information and content. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples - consider license-related regulation principles of use and publication fo information - understand copyright and license rules - distinguish different ways of licensing intellectual property - understand differences between copyright, creative commons, copyleft and public domain licenses - license own original production - find information on copyright and license rules - behave independently and assume responsibility for own behaviour and choices He/She is able to... - distinguish copyright and license matters particularly relevant to care recipients - mediate the User skills to care recipients - support care recipients in adopting the User skills - promote to care recipients the importance of lawful use of online resources - protect care recipients from unintended copyright violation 56

57 Competence domain Competence area Competence title Competence description A General digital competence 3 Content creation 3.4 Producing multimedia and creative outputs Improving and innovating with ICT; actively participating in collaborative digital and multimedia production; expressing self creatively through digital media and technologies; creating knowledge with the support of technologies. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - understand how meaning is produced through multimedia (text, images, audio, - identify the benefits of audio-visual means of expression for the lives of care video) recipients - give examples of various ouputs produced by digital media - explain how using multimedia can enhance care recipients contacts with family, - explore the possibility of hyper-texts peers, communities and carers - explain how creative work with media can help maintain and strengthen care recipients cognitive powers - use a variety of media to express him/herself creatively (text, images, audio, - mediate the User skills to care recipients video) - support care recipients in adopting the User skills - use common software packages to work with images, audio, video, graphics - edit content in order to enhance the final product - realise the potential of technologies and media for self-expression and - guide care recipients through different ways of creating and usng multimedia to knowledge creation preserve creativity and cognitive powers - recognise the added value of new media for creative and cognitive processes - promote exploitation of audio-visual culture for socialising purposes - engage with creative content 57

58 Competence domain Competence area Competence title Competence description A General digital competence 3 Content creation 3.5 Programming Programming applications, software, devices; understanding the principles of programming; understanding what is behind programmes. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - explain how digital systems and processes work - assess the extent to which care recipients can benefit from - understand the basics of software meta-operation carers programming skills - create models, simulations and visualisations of the world using - set-up and program care recipients smart devices (e.g. vital sign digital information and means monitors, alarms, reminders, multifunctional smart objects) - code and program digital applications and devices - adjust software and application settings to the needs of care recipients - be curious about the processes enabling the use of ICTs - observe that care recipients are not discouraged by the - explore the possibilities of programming and creation of outputs complexity of technological meta-information - support care recipients who are curious about technological meta-information and programming 58

59 Competence domain Competence area Competence title Competence description A General digital competence 4 Safety 4.1 Protecting devices Protecting own devices and understanding related risks and threats; applying safety and security measures. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - become aware of risks associated with using digital devices - assess care recipients general ability to use digital devices - distinguish between basic principles of handling digital devices safely - give examples of measures to protect devices from damage and - identify various scenarios of damaging devices and describe wear-out appropriate preventive measures - initiate, set-up and control safe operation of various digital - mediate the User skills to care recipients devices (mobile/smart phones, tablets, laptops, table computers, - support care recipients in adopting the User skills digital cameras, audio devices, specialised health and care aids) - use safety accessories to protect devices from physical damage and wear-out - examine malfunctioning devices and decide where professional service is needed - read and observe user manuals and operation instructions for - promote to care recipients the importance of referring to user devices manuals and operation instructions for devices - use devices sustainably and economically - prioritise the safety of care recipients over the protection of devices and equipment 59

60 Competence domain Competence area Competence title Competence description A General digital competence 4 Safety 4.2 Protecting data and digital identity Understanding common terms of service; actively protecting own data; respecting other people's privacy; protecting self from online fraud, threats and cyberbullying. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples - understand the terms of use of online services (e.g. collection of personal data by providers) - give examples fo up-to-date strategies to protect own systems and data - realise the visibility of own digital footprint - understand the risks of identity theft and other credentials theft - install and use various anti-virus systems and applications - take steps to mitigate risks of fraud by using strong passwords - monitor own digital footprint - modify or delete information about self or others he/she is responsible for - follow the principles of online privacy and safety - act critically when disclosing information about him/herself of others online He/She is able to... - explain why care recipients can be particularly vulnerable to online misconduct, fraud and other threats - give examples of assistance and protective measures to be offered to care recipients in relation to data protection - understand carers responsibilities and considerations when handling care recipients private or otherwise sensitive information - mediate the User skills to care recipients - support care recipients in adopting the User skills - combine data protection with respect to care recipients privacy - ensure that care recipients keep track of all security measures they take (e.g. passwords and PIN codes applied, user accounts created) 60

61 Competence domain Competence area Competence title Competence description A General digital competence 4 Safety 4.3 Protecting health Avoiding health-risks related with the use of technology in terms of threats to physical and psychological well-being. Application level User Guide/Mentor He/She is able to... Knowledge examples - understand various effects of using technology on users health - distinguish real risks from common myths as regards health threats caused by technology - be aware of basic principles for the protection of physical and mental health related to digital technology use - understand general and specific health risks imposed on care recipients using ICTs - adjust the type and extent of digital engagement to care recipients particular capacities and health condition - identify potential threats to care recipients physical and mental health related to using ICTs Skills examples - protect own physical health when using ICTs by taking appropriate preventive measures (e.g. correct physical posture by computer, correct - mediate the User skills to care recipients - support care recipients in adopting the User skills light conditions and optimal distance from the device) - protect own mental health when using ICTs by taking appropriate preventive measures (e.g. avoiding harmful content, balancing activities) Attitudes examples - demonstrate balanced and healthy attitude towards using technology - challenge care recipients unsubstantiated preconceptions about health risks posed by technology - support preventing real health risks 61

62 Competence domain Competence area Competence title Competence description A General digital competence 4 Safety 4.4 Protecting the environment Being aware of the impact of ICT on the environment; observing principles of efficiency and effectiveness. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - determine appropriate and safe digital means - take into account economic possibilities of care recipients or - compare efficiency and cost-effectiveness of various ICTs their families as regards use of ICTs - understand the environmental impact of ICTs and other - explain to care recipients the principles of cost-efficiency and electronic devices time-efficiency related to digital technologies - advise care recipients on environmental aspects of ICTs - use digital equipment cost-efficiently and time-efficiently - mediate the User skills to care recipients - make good purchasing decisions (e.g. about buying devices or - support care recipients in adopting the User skills internet services) - recycle ICTs and their parts where possible - recognise environmental and economical issues related to the use of digital technology 62

63 Competence domain Competence area Competence title Competence description B Enabling digital competence in social care work 5 Acceptance 5.1 Role of digital competence in care work Understanding the role of digital competence in care work; understanding how different kinds of digital technology can support care workers in their profession as well as care recipients in their daily lives; realizing the benefits and challenges of implementing ICT in social care. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - give examples of everyday uses of digital technology - explain how digital technology can benefit care recipients - describe a digitally competent person - give examples of digital technology already used by care recipients - explain how digital technology can benefit the work of carers - describe common challenges preventing care recipients from using - describe different ways of applying digital technology in own practice digital technology and improving their digital competence - assess own level of general digital competence - estimate care recipients current attitude towards digital technology - search for national and international examples of practices and projects - evaluate care recipients willingness to accept digital technology and in digitally supported care work improve their digital competence - select good practices applicable in own work - assess care recipients current level of general digital competence - adopt positive attitude towards digital technology - maintain positive as well as realistic approach to the role of digital - demonstrate willingness to gain and/or improve own digital competence competence in care recipients lives 63

64 Competence domain Competence area Competence title Competence description B Enabling digital competence in social care work 5 Acceptance 5.2 Inception and promotion Bringing digital competence and technology into own work practices; clarifying the advantages of digital technology to care recipients; introducing various types and possibilities of digital activity to care recipients; inspiring interest in ICT. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - understand how digital technology brings more efficiency and - understand the particulars of introducing digital technology to the elderly effectiveness to the performance of common and traditional carer s work - understand the need for a tailored individualised approach to tasks introducing digital technology to care recipients - describe new work tasks brought to carers by digital technology - analyse own work practices - help care recipients to understand the basic concept of digital - identify work tasks, processes, procedures and routines where digital technology technology can be effectively used - explain to care recipients the advantages and challenges of using digital - realise the transition to using digital support in suitable work tasks technology - build on the technology already used by care recipients - promote the effects and outcomes of using ICT rather than the technologies and processes involved - demonstrate motivation to introduce digital technology to enhance own - inspire in care recipients interest in digital technology work - promote ICT gradually, naturally, and with regard to individual circumstances 64

65 Competence domain Competence area Competence title Competence description B Enabling digital competence in social care work 5 Acceptance 5.3 Encouragement and confidence building Overcoming psychological obstacles to the implementation of digital technology in care work such as the fear and mistrust of technology, low self-esteem and lack of interest; encouraging care recipients to gradually discover ICT-based activities; building confidence. Application level User Guide/Mentor Knowledge examples Skills examples He/She is able to... - understand social, economical and psychological factors that have - understand social, economical and psychological factors that have impact on the use of ICT by carers impact on the use of ICT by care recipients - reflect on own subjective and objective barriers to adopting ICT - define strategies to address common prejudices towards ICT - search and find reliable information to address own as well as care - address care recipients mistrust in digital technology by communicating recipients questions about the safe and easy use of ICT a realistic conception of risks and how they can be addressed. - communicate information on digital technology clearly, objectively and - address care recipients fear of digital complexity by introducing easyto-use confidently and ambient solutions - enhance care recipients self-esteem and motivation through tailored and target-oriented learning strategy - expose and challenge common myths and misconceptions about ICT Attitudes examples - demonstrate willingness to overcome own reservations towards ICT - cultivate understanding for the concerns and worries of others - address care recipients concerns seriously and objectively - act as an informed and trustworthy advisor 65

66 Competence domain Competence area Competence title Competence description B Enabling digital competence in social care work 5 Acceptance 5.4 Sustainability Ensuring user-friendliness and adequacy of digital technology used by the care recipient; avoiding overcomplexity and high costs; observing sustainable user development; preventing discouragement and loss of interest. Application level User Guide/Mentor He/She is able to... Knowledge examples - understand the possibilities and limits of digital technology - understand the priority of user experience - provide overview of basic ICT user strategies and goals - understand the limitations of individual care recipients capacity to use ICT - anticipate the adequacy of different digital solutions for different users Skills examples - evaluate relevance and suitability of different kinds digital technology in different contexts - select digital devices and applications with regard to own needs and work tasks - test-use and evaluate the relevance of different digital technologies - observe balance between care recipient s digital and non-digital activities - determine the level of user-friendliness of different technologies - ensure cost-effectiveness and economy of the digital solutions used - support continuous interest and self-development of care recipients - adapt technologies to care recipient s circumstances Attitudes examples - combine optimistic and critical attitude towards digital technologies - prioritise care recipient s needs over technological requirements - cultivate care recipient s curiosity and optimism as well as critical assessment of digital possibilities 66

67 Competence domain Competence area Competence title Competence description B Enabling digital competence in social care work 6 Adaptation 6.1 Identification of digital needs Identifying own as well as care recipients' needs that can be addressed by digital technology; inspecting own as well as care recipients' daily practices, routines, interests and wishes and determining where digital technology can provide more effectiveness, efficiency and comfort. Application level User Guide/Mentor He/She is able to... Knowledge examples - understand that digital technologies are tools to address specific needs - distinguish between personal and work-related needs - explain how to analyse care recipients common and individual needs, daly practices, routines, interests and wishes - give examples of typical care recipients needs that can be addressed by digital technology Skills examples - inspect own personal needs, routines, interests and wishes - inspect own care-work practices - identify in own personal as well as work-related pactices the needs that can be addressed by digital technology - consult peers and professional sources to find out about different ways of care-work-related application of ICTs - communicate with care recipients about their needs and interests - observe care recipients routines, habits, feelings and wishes - synthesise observation-based information on care recipients daily lives into formulation of needs - decide which needs can be addressed by digital technology Attitudes examples - apply digital solutions where they are effective and efficient - apply individual, case-by-case focus when observing digital needs of care recipients while allowing room for generalisation - observe care recipients comfort and well-being when identifying digital needs 67

68 Competence domain Competence area Competence title Competence description B Enabling digital competence in social care work 6 Adaptation 6.2 Identification of digital responses to needs Identifying, based on own and care recipients's needs, appropriate digital solutions, strategies and activities; matching areas of need with available solutions; evaluating solutions and selecting ones best fitting particular situation's/person's context. Application level User Guide/Mentor Knowledge examples He/She is able to... - understand how identified needs can be linked to digital responses - understand that care recipients might not be able to match their needs with - have overview of a variety of ICTs and digital solutions digital technology Skills examples Attitudes examples - transform identified digital needs into search words and browsing strategies - match categories of needs with corresponding areas of ICTs and online services - test various ICTs and services against his/her personal and work-related requirements - decide which ICTs and services best address his/her needs - apply digital solutions where they are effective and efficient - broaden and deepen constantly own insight in digital technology to discover ever more adequate responses to needs - help care recipients realise the connections between daily activities and digital technology - demonstrate to care recipients examples of digital alternatives to traditional activities (e.g. writing a letter vs. writing an ; using paper notes vs. using an online planner; making phone calls vs. making skype calls) - assist care recipients in testing, adopting and/or replacing different digital responses to their needs - introduce ICTs to care recipients based on real needs - realise that different individuals with the same needs may prefer different digital solutions 68

69 Competence domain Competence area Competence title Competence description B Enabling digital competence in social care work 6 Adaptation 6.3 Tolerance and patience Communicating digital technology to care recipients in appropriate manner; adjusting the pace of learning to individual capacities and objective setbacks; dealing with failure and finding alternative solutions; promoting cooperative optimism; maintaining realism in expectations. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - understand that people learn new things at different speed and - explain why tolerance and patience are generally useful when through different techniques dealing with care recipients adoption of digital competence - identify own learning preferences, habits and practices as well - give examples of areas where care recipients may encounter as those of others learning difficulties - adjust own way towards digital competence accordingly - adjust teaching and learning techniques to care recipients - set him/herself and others realistic targets and learning individual capacities and objective setbacks objectives - introduce new information to care recipients only after ensuring - transform own mistakes into useful lessons for him/herself as that previous information has been sufficiently processed well as for others - deal constructively with care recipients failure and mistakes - maintain optimism and constructiveness in learning - ensure unceasing support and reassurance to care recipients is - be open to changing priorities and adapting goals given 69

70 Competence domain Competence area Competence title Competence description B Enabling digital competence in social care work 6 Adaptation 6.4 Variability, creativity and resourcefulness Supporting variability in digital technologies used and activities carried out; helping care recipients discover the creativity and diversity of digital environments; preventing stereotypisation and boredom; providing orientation and guidance; helping with systematisation. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - recognise the diversity of digital technologies available - explain to care recipients the richness of digital possibilities - distinguish different digital user strategies - identify tendencies to stereotypisation and loss of interest in care recipients digital activity - find alternative digital solutions for identified needs - introduce to care recipients a variety of available digital tools, - change digital strategies where appropriate applications and methods to carry out common activities - combine different devices and application according to work-task - engage care recipients in new digital activities and services requirements - update regularly the portfolios of digital services used by - test new formats and platforms individual care recipients - assist care recipients in systematising their digital portfolios, accounts and identities - maintain variability of own digital activity while preserving - observe the risks of digital addiction systematic approach - encourage resourcefulness and innovation 70

71 Competence domain Competence area Competence title Competence description B Enabling digital competence in social care work 7 Progression 7.1 Learning together Strengthening the social bond between care worker and care recipient through the process of discovering digital technology together; balancing the role of guide with that of peer learner; identifying areas of common interest; promoting reciprocity, openness and cooperation; preserving mutual trust. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - explain how his/her own digital learning can benefit from working - understand the social bond between carer and care recipient with care recipients - explain how the social bond can be strengthened by learning - give examples of areas of digital activity that can be explored together together with others - give examples of socialising activities related to discovering - define the concepts of reciprocity / cooperation / respect digital technology - search advice when learning about digital technology - set up learning plans to involve care recipients in mutual digital - consult others to solve digital problems and address needs learning - join peer learning platforms and communities - balance own role of guide with that of peer learner - establish peer learning platforms and communities - exploit areas of common interests with and/or between care recipients - organise group learning sessions bringing care recipients together - recognise the value of second opinion - approach care recipients as a peer learners rather than pupils - promote reciprocity and openness in digital learning - acknowledge care recipients input in digital learning strategies 71

72 Competence domain Competence area Competence title Competence description B Enabling digital competence in social care work 7 Progression 7.2 Evaluation of progress Setting learning targets; observing own and care recipients' advancements in digital competence; verifying acquisition of specific knowledge and skills; mapping the progress on competence frameworks and individual plans. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - have overview of elementary components of digital competence - understand individual progress pace of care recipients - explore various digital competence frameworks - adapt various digital competence framworks - set own digital learning targets - consult various digital competence frameworks to map care - define timelines for own digital learning recipients digital progress - check regularly own progress in digital competence against set - help care recipients set individual digital learning targets criteria - check with care recipients their progress against set targets - build on own advancements to identify new learning goals - emphsise care recipients advancements to motivate further progress - acknowledge the function of external digital competence - avoid the risks of rigid and/or linear evaluation of progress systems while observing individual contexts and needs - maintain objectivity and systematic approach to evaluation of progress 72

73 Competence domain Competence area Competence title Competence description B Enabling digital competence in social care work 7 Progression 7.3 Feedback and modification Reflecting with care recipients regularly on the advantages and challenges brought in their lives by digital technology; addressing obstacles; giving constructive and sensitive feedback; acknowledging achievements; modifying care recipients' digital user strategies and learning plans where appropriate. Application level User Guide/Mentor He/She is able to... Knowledge examples - understand principles of self-reflection - realise benefits as well as challenges brought to care recipients - give examples of own strengths and weaknesses as regards digital competence lives by digital technology - understand principles of constructive feedback and motivation - give examples of positive and negative feedback Skills examples - reflect on own digital competence in terms of modification and adjustment - modify own digital user and learning strategies - listen actively to care recipients explicit as well as implicit notions about the role of ICTs in their lives - reflect with care recipients on specific obstacles and modification needs as regards their digital activities - give constructive and sensitive feedback - propose alternative learning paths and/or areas of activity - acknowledge care recipients achievements - modify care recipients digital user and learning strategies Attitudes examples - maintain integrity and authenticity in reflecting own self - maintain integrity and authenticity in reflecting others 73

74 Competence domain Competence area Competence title Competence description B Enabling digital competence in social care work 8 Support 8.1 Guidance and mentoring Guiding care recipients through all stages of acquisition of digital competence according to individual needs and capabilities; mentoring and consulting; building on achievements and addressing challenges; responding to both explicit and tacit needs of assistance; promoting care recipients' autonomy and active approach. Application level Knowledge examples Skills examples Attitudes examples User He/She is able to... Guide/Mentor - define main characteristics and responsibilities of a guide/mentor working with care recipients - address care recipients explicit questions, problems, requests regarding digital technology - identify non-verbalised problems and needs for assistance regarding digital technology - provide advice on digital technology where possible - consult online sources, experts and service providers where needed - perform guidance as partner and facilitator rather than teacher or lecturer - estimate realistically own capacity for ICT-related counselling 74

75 Competence domain Competence area Competence title Competence description B Enabling digital competence in social care work 8 Support 8.2 Technical, instrumental and organisational assistance Performing basic technical operations; setting-up and launching standard equipment and applications; solving non-complex technical problems; trouble shooting; arranging for expert assistance in more complex problems; assisting care recipients in dealing with service providers and other external stakeholders. Application level User Guide/Mentor He/She is able to... Knowledge examples - have basic overview of technical aspects of ICTs operation - keep overview of hardware/software used by care recipients - give examples of most common technical problems and malfunctions of ICTs - keep overview of digital services provided by external parties to care recipients Skills examples - operate on user level a variety of digital hardware (e.g. initiate new devices, plant and charge batteries, connect devices with each other, switch-off safely) - operate on user level a variety of software and applications (e.g. download and install, launch and close, set-up user settings, update, uninstall) - analyse causes of minor technical/instrumental problems - mediate the User skills to care recipients where possible/appropriate - exercise own User skills on care recipients ICTs where possible and safe - search expert assistance where needed - mediate care recipients contacts with external parties (e.g. internet connection providers, mobile network operators, service companies) - trouble-shoot minor technical/instrumental problems Attitudes examples - approach technical/instrumental tasks safely but confidently - challenge unsubstantiated fear of technology and technical tasks - remain realistic about own and care recipients technical/instrumental competence 75

76 Competence domain Competence area Competence title Competence description C Occupation-specific and advanced digital competence in care work 9 Assistive technologies 9.1 Alarms and emergency aids Helping care recipients understand, install and use alarms and emergency aids; explaining to care recipients the purposes and operation scenarios of such devices; ensuring constant fuctionality of alarms; observing own reachability by remote emergencies; responding to emergencies and organising due measures; dealing with accidental and panic-driven alarms. Application level User Guide/Mentor He/She is able to... Knowledge examples - distinguish personal alarm and emergency aid systems used for care and health purposes - understand how alarms and emergency aids work - distinguish different digital devices that can perform the function of alarms - define preventive functions of alarms and emergency aids - explain the purpose and operation of alarms to care recipients - give examples of emergency situations where alarms and emergency aids are used and emergency aids Skills examples - set up alarms and emergency aids - test functionality of alarms and emergency aids - inspect functionality of alarms and emergency aids regularly - solve minor technical problems with alarms and emergency aids - mediate service of malfunctioning alarms and emergency aids - ensure that alarms and emergency aids function constantly - explore with care recipients usage scenarios of alarms and emergency aids - respond to remotely set-off alarms appropriately and in consecutive steps (e.g. contact the care recipient, contact health services, arrange inspection, make inspection) - handle accidental and panic-driven alarms Attitudes examples - cope with the responsibility of a receiver of alarms and emergency calls - make him/herself reachable by alarm calls at all due times 76

77 Competence domain Competence area Competence title Competence description C Occupation-specific and advanced digital competence in care work 9 Assistive technologies 9.2 Time organisation and daily activities assistance Familiarising with various digital solutions for the organisation of time and planning of daily activities; utilising such means in the organisation of own work in relation to scheduling client visits or coordinating activities with other care workers; assisting care recipients in utilising time organisers and memory aids, especially in relation to scheduling medical and care visits, medication reminders, planning and reminders of other daily personal and social activities. Application level User Guide/Mentor He/She is able to... Knowledge examples - distinguish various digital solutions for time organisation - understand principles of time management and multitasking - explain the importance of timeliness and regularity in care recipients lives - define problems caused by memory loss and temporal confusion - give examples of care recipients routines and daily activities that can be assisted by digital time organisation tools and memory aids Skills examples - use various digital time organisation applications (e.g. online calendars, reminders, task planners, doodle) - plan own care work visits and other work tasks - synchronise various digital devices with own and others schedules - assist care recipients in transition to digitally-supported time organisation - program care recipients digital reminders and memory aids to plan e.g. care visits, medical visits, medicament intake, self-monitoring checks - assist care recipients in using digital time organisation to keep track of personal and social activities such as meetings with family and peers, phone calls, community events Attitudes examples - ensure own reliability and integrity in terms of time - respect care recipients privacy and personal choices when assisting in their time management 77

78 Competence domain Competence area Competence title Competence description C Occupation-specific and advanced digital competence in care work 9 Assistive technologies 9.3 Impairment aids and corrections Achieving an understanding of various technology-based impairment aids and corrections such as electronic hearing aids, optical aids, electronic voice assistants, orientation and mobility aids, etc.; providing assistance to care recipients in induction, adjustment, use and maintenance of such devices; mediating expert assistance and service where appropriate. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - distinguish between various technology-based impairment aids and - give examples of care recipients impairments that can be mitigated by corrections (e.g. electronic hearing aids, optical aids, voice assistants, electronic aids and corrections orientation and mobility aids) - understand advantages and limitations of using impairment aids and - have an understanding of how electronic impairment aids function corrections - define the extent to which using different electronic impairment aids requires expert technical and medical assistance - follow technical manuals, user instructions and medical instructions for the - mediate technical and medical information on the use of impairment aids use of impairment aids and corrections and corrections to care recipients - consult specific application issues related to impairment aids with - assist care recipients in installation, usage, maintenance and adjustment of professionals impairment aids and corrections - enhance continuously own expertise in the operation of impairment aids and - observe care recipients safe use of impairment aids corrections - discriminate clearly and realistically between carers tasks related to impairment aids and those remaining with technical/medical professionals 78

79 Competence domain Competence area Competence title Competence description C Occupation-specific and advanced digital competence in care work 9 Assistive technologies 9.4 Mobile smart objects and devices Understanding and using, for care purposes, mobile smart objects and devices such as smart phones, tablets, smart aids; assisting clients in introduction, set-up, use and maintenance of smart objects and devices; updating smart contents and applications; ensuring inter-operability with other digital technology; configuring smart objects' functions in accord with care recipients' individual needs and circumstances. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - understand available smart objects/devices and their functions - explain to care recipients the concept and possibilities of mobile smart objects - recognise the difference between smart and non-smart mobile objects (e.g. - give examples of mobile smart objects potential usage scenarios in the lives of between a smart phone and a traditional mobile phone) care recipients - exploit the functions and possibilities of mobile smart objects - assist care recipients in exploring mobile smart objects - operate smart phones and tablets - configure care recipients smart phones and tablets to ensure ease of use and - utilise a variety of available smart applications for the purposes of care work adequacy of content - operate specialised smart objects designed for care purposes (e.g. Li1) - program specialised mobile smart objects such as Li1 to allow care recipients - synchronise different mobile smart objects to ensure inter-operability utilise their functions (easy calling, audio guidance) - identify smart applications useful to care recipients (e.g. easy networking, time organisation, health information, cognitive training, leisure time activities) - keep track of new developments in the area of smart objects and applications - promote to care recipients the intuitiveness and non-complexity of mobile smart - be proactive in adapting own work practices towards more efficiency and objects and applications effectiveness provided by mobile smart objects - balance care recipients usage of individual-oriented applications (e.g. games) with socialising applications (e.g. communication apps and social networks) 79

80 Competence domain Competence area Competence title Competence description C Occupation-specific and advanced digital competence in care work 9 Assistive technologies 9.5 Ambient Assisted Living and smart homes Understanding the basics of the concept of care-based smart homes and other complex systems in the field of Ambient Assisted Living; pro-actively exploring innovations in the area; participating in practical implementation of related technologies; assisting care recipients interested in finding out more about smart homes and other complex systems. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - explain basic principles of the concept of Ambient Assisted Living (AAL) and - understand how smart homes assist and benefit their residents smart homes - understand challenges related to the concept of smart homes (e.g. costs - give examples of functions, mechanisms and services applied in smart considerations, ethical issues of continuous monitoring) homes - explore innovations in the field of AAL - assist in implementing AAL principles in care recipients lives - implement AAL concepts, solutions and approaches in own care work - guide care recipients through services and functions provided by smart practice homes and other AAL elements (e.g. complex monitoring systems, - contribute to the development and implementation of AAL by sharing own domiciliary communication networks) care work knowledge and experience - advise care recipients and their families interested in AAL possibilities - support actively the implementation of AAL - promote to care recipients the advantages of AAL while also disclosing the - maintiain a realistic attitude towards present possibilities and future challenges such as costs and ethical issues developments in AAL 80

81 Competence domain C Occupation-specific and advanced digital competence in care work Competence area Competence title Competence description 10 ehealth 10.1 Vital sign monitoring, self-diagnosis and treatment systems Helping care recipients understand, set-up, use and maintain vital sign monitoring and self-diagnosis systems such as digital blood pressure measures, cardio-monitoring devices, diabetic diagnostical devices, urine self-test devices, etc.; assisting care recipients in reading, interpreting and recording results of measurements; ensuring correct operation of devices and validity of measurement data. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - distinguish various functions of vital sign monitoring devices and self-diagnosis - relate elementary monitoring and self-diagnosis systems to typical health systems based on digital technology (e.g. measuring blood pressure, cardiomonitoring, conditions of care recipients diabetic diagnostics, medicament implementation, urine testing) - distinguish between preventive systems and treatment implementation devices - apply digital self-diagnosis and treatment systems on self and/or others - introduce common digital self-diagnosis systems to care recipients including - read data provided by self-diagnosis systems set-up and adjustment - interpret data provided by self-diagnosis systems - assist care recipients in understanding data provided by self-diagnosis systems - prepare and apply treatment implementation devices (e.g. digital insulin injections) - prevent incorrect use of self-diagnosis systems and misinterpretation of data where appropriate - ensure adequate and timely use of treatment implementation devices (e.g. digital insulin injections) - assess adequately own medical knowledge and capacity to operate diagnosis and - promote care recipients preventive usage and objective attitudes towards selfdiagnosis treatment devices and interpret measurement findings and monitoring - seek professional medical advice/assistance where necessary - prevent overuse and obsessiveness in self-diagnosis practices 81

82 Competence domain C Occupation-specific and advanced digital competence in care work Competence area Competence title Competence description 10 ehealth 10.2 Telemedicine and telecare Understanding the concept of remote care and monitoring systems; understanding main technologies in the area; participating in remote monitoring of care recipients; dealing with requests for remote assistance; consulting care recipients via phone, skype and other communication technologies; observing a balance between remote and personal care; observing the ethical dimension of telecare. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - understand the specifics of remote care and montoring - give examples of care recipients needs that can be addressed by - understand the particulars of different technologies used in telemedicine and telemedicine and telecare telecare - define communication strategies and methods applied in remote counselling - use different digital devices to provide care and counselling from distance - assist care recipients in setting-up means of remote care requests (e.g. (landline phones, mobile phones, smart phones, table computers, laptops) insert relevant phone numbers into mobile phones, install messaging - use different digital applications and services to provide care and counselling applications, create accounts and online community accounts) from distance ( , skype, messaging services, chat rooms, online - train care recipients in making remote care requests communities and platforms) - set up remote monitoring devices in care recipients settings (e.g. - observe remote monitoring data movement monitoring, fall monitoring, medication intake monitoring) - respond to non-standard situations suggested by remote monitoring data - decide on appropriate balance between remotely performed care - maintain individual and context-aware attitude even when attending to care assistance/counselling and direct personal care work recipients from distance 82

83 Competence domain C Occupation-specific and advanced digital competence in care work Competence area Competence title Competence description 10 ehealth 10.3 Digital support to physical activation and rehabilitation Supporting care recipients' physical activation and rehabilitation through digital technology such as exercise aids, activity planners, and tailored fitness programmes, etc.; preventing non-activity by complementing physically passive digital activities with active ones according to individual care recipient's possibilities and conditions. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - give examples of digital devices and applications that can support physical activity, - explain the benefits that maintaining physical activity can bring to care exercise, movement and rehabilitation recipients - distinguish care recipients whose health condition allows for physical activity - search online for information and guidance on physical activation, exercise and - introduce to care recipients a variety of digital exercise aids, physical activity rehabilitation activities planners and demonstrative fitness programmes - identify specific fitness and exercise programmes and applications that can be - perform exercises with care recipient using smart phones, tablets, computers, used in, or adapted for, care work DVDs or television programmes - prepare adapted physical rehabilitation plans using online resources and with the - establish physical rehabilitation group sessions involving multiple care support of digital devices recipients - advise care recipients how and where to search online for more information on physical activities - serve as example of healthy lifestyle and pro-activeness - take into account various limitations and impairments influencing care - follow professional/medical advice when planning and performing physical recipients physical condition and capabilities activities with care recipients - observe care recipients safety and security in physical activities 83

84 Competence domain C Occupation-specific and advanced digital competence in care work Competence area Competence title Competence description 10 ehealth 10.4 Digital recording and processing of health data Monitoring digitally generated data on care recipients' health; using digital technology to record, store, systematise, analyse and process the data in cooperation with care services and medical professionals. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - distinguish between various ways of retrieving, processing and storing data - understand the particulars of health monitoring systems used by care through digital technology recipients and of the ways they produce processable data - define various categories of health data that can be digitally recorded and - distinguish data to be shared with care recipients, their families, medical processed professionals and other stakeholders - retrieve care recipients health data from different monitoring and diagnostical - assist care recipients in producing their health data devices - share with care recipients appropriate categories of health data by creating - use programmes and applications to process and organise health data e.g. weekly/montly overviews, thematic infographics and reports collected (e.g. spreadsheets, simple databases, specialised smart applications, - feed care recipients health data into medical databases and health care image editors, graphic programmes, presentation programmes, online storage systems where required and sharing spaces) - observe confidentiality and sensitivity of health data - communicate to care recipients clearly and fully the purposes, objectives - act ethically at all stages of monitoring, retrieving, processing and storing of and benefits of digital recording and processing of their health data health data 84

85 Competence domain C Occupation-specific and advanced digital competence in care work Competence area Competence title Competence description 11 Professional development 11.1 Digital permanency and updating Keeping up with developments in digital technology in general as well as its implementation in care sector; exploring new and alternative solutions to care-related problems; planning own progress in digital competence according to competence frameworks and maps. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - explain how enhancing digital competence can be relevant for care workers - explain how enhancing digital competence of carers can improve the professional development and employability quality of life of care recipients - distinguish various ways to develop and update own digital competence and ICT literacy - give examples of sources of information on implementing digital technology in care work - search online for information on digital technology in care work - evaluate the effects of enhancing his/her digital competence on care - apply digital developments in care work to own work practices recipients - identify different digital solutions to specific care problems to decide on ones - collect care recipients views on his/her digital progress and on the appropriate to his/her particular work contexts resulting changes of care patterns - consult digital competence frameworks and maps to plan own learning and progress - seek continuous improvement of his/her digital competence - transform the continuous improvement of his/her digital competence into - exploit new possibilities to implement his/her digital competence in practical the benefit of care recipients care work 85

86 Competence domain C Occupation-specific and advanced digital competence in care work Competence area Competence title Competence description 11 Professional development 11.2 E-learning Improving own professional competences in care work by engaging in various kinds of e-learning activities; finding open source learning resources and pathways; organising own e-learning activities through online courses and programmes; self-assessing learning results via evaluation exercises. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - understand that learning can take place through digital means and resources - give examples of special learning needs of care recipients - have an understanding of various types of e-learning programmes, modules, - distinguish areas of e-learning relevant for care recipients in general and open-source learning resources and pathways, e-learning communities and for individual care recipients in particular forums - plan own e-learning according to identified needs and areas of interest (e.g. - plan care recipients e-learning according to identified needs and areas of by consulting digital competence frameworks) interest (e.g. by consulting digital competence frameworks) - take e-learning courses, modules and classes systematically - mediate relevant e-learning courses, communities and resources to care - join and participate actively in e-learning communities and forums recipients - access open source learning resources and pathways - adapt e-learning schemes to care recipients needs where adequate - assess own learning results through evaluation exercises and selfassessment - assist care recipients in self-assessment exercises - use e-learning resources as support to face-to-face training sessions with care recipients - approach e-learning as both personal interest and a means to social and - support care recipients active ageing through learning new information and professional mobility skills 86

87 Competence domain C Occupation-specific and advanced digital competence in care work Competence area Competence title Competence description 11 Professional development 11.3 Peer learning and exchange of good practices Engaging in peer communities of care workers and caregivers; participating actively in the exchange of good practices; publishing and consulting online examples from own work and from the work of others; identifying local as well as remote care work groups and associations and contributing to their activities; coordinating with peer care workers the services provided to common or related care recipients. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - distinguish various ways how digital technology allows for collaboration, - understand how digitally supported collaboration between peer care exchange of information and peer cooperation workers can streamline care services and benefit care recipients - search existing communities of care workers and caregivers as well as - reply to information requests of peers by providing own knowledge, networks of organisations and associations experience and feedback - publish online own knowledge, experience and work outcomes - share with peers the care-related information about common or related - consult with online peer communities about various issues related to care care recipients while observing privacy and safety issues work - coordinate work tasks with other carers via online planning and - establish new digital peer networks and engage peers and organisations collaboration systems/networks/databases - adapt best practices shared by peers to his/her own cotexts of work - utilise knowledge on care networks and organisations for job-search purposes - recognise the value of peer exchange and cooperation - maintain own professional integrity and ethical behaviour when sharing - be willing to share own knowledge and good practices with peers information on care recipients with peers 87

88 Competence domain C Occupation-specific and advanced digital competence in care work Competence area Competence title Competence description 11 Professional development 11.4 Specialisation and certification Identifying specific areas of digital competence to establish the ones in which one is particularly interested; pursuing improvement in such areas; working towards specialisation and acquisition of expert knowledge and skills; understanding the purpose of certification; validating one's learning outcomes through certificates, diplomas and other means of formal recognition. Application level Knowledge examples Skills examples Attitudes examples User He/She is able to... - understand how specialisation and expertise can enhance his/her employability - identify areas of digital competence that he/she is particularly interested in - understand the particulars of training programmes and certification schemes at the interface of care work and digital competence - collect information on special areas of digital competence systematically - broaden and deepen own competence in special areas of digital competence - consult qualification and assessment standards - consult care work associations to analyse current skills needs in the sector - validate own learning outcomes through certificates, diplomas and other means of formal recognition - exploit his/her interests and talents in order to pursue specialisation and expertise - acknowledge the value of formal recognition and certification of skills and competences Guide/Mentor 88

89 Competence domain C Occupation-specific and advanced digital competence in care work Competence area Competence title Competence description 12 Administration and management 12.1 Mobile administration of field work Using mobile digital devices to administer care work performed; monitoring own field work with positioning equipment; tracking through mobile devices the places visited and recording the activities carried out; ensuring flexible reactions and real-time response to care recipients' needs as well as to instructions from care service organisations. Application level User Guide/Mentor Knowledge examples Skills examples Attitudes examples He/She is able to... - distinguish various digital devices that can support mobile field work (e.g. mobile phone, smart phone, tablet, laptop, GPS positioning tools) - understand how different applications and software can support mobile field work (e.g. time and route planners, map applications, code readers, check-in and tracking apps, databases) - access, during field work, digital databases of care recipients data including - introduce to care recipients various digital tools for confirming and recording location, health-condition, frequency of visits, care tasks required, special needs care visits and activities realised (e.g. electronic signature, assignment of specific - respond to field-work situations in real time through mobile digital devices bar and QR codes, chip cards) - track his/her care visits through positioning applications - feed the outputs of care recipients health diagnostics recorded during care - access instructions from his/her care organisation during field work visits into online systems operationally - synchronise with other carers during field work - make him/herself available for instant field reaction through a variety of digital - balance digitally supported recording activities during care visits with personal communication means attitude, communication and socialising with care recipients 89

90 Competence domain C Occupation-specific and advanced digital competence in care work Competence area Competence title Competence description 12 Administration and management 12.2 Planning, monitoring, reporting Using digital devices and appropriate software to independently plan, monitor and report care activities; using care organisations' systems dedicated to planning, monitoring and reporting care work. Application level Knowledge examples Skills examples Attitudes examples User He/She is able to... - distinguish between applied care work and its support by planning, monitoring and reporting tasks - have overview of devices and applications that can be used to plan, monitor and report care activities - use basic office software packages to create or fill in administrative forms and templates - operate basic office equipment (e.g. printers, scans, card readers) - use care organisations administrative systems and databases to plan, monitor and report his/her work - digitalise hardcopy care documentation (e.g. by scanning and storing receipts, medical reports, images) - submit digital reports and work-hours sheets - synchronise his/her monitoring /tracking devices with care organisations systems - recognise the importance of rigorous planning, monitoring and reporting of his/her work Guide/Mentor 90

91 Competence domain C Occupation-specific and advanced digital competence in care work Competence area Competence title Competence description 12 Administration and management 12.3 Digital management of service in care organisation Using care organisations' systems for managing care workers; participating in coordination and monitoring of work of others through digital technologies; undertaking supervision and leading roles in care organisations through digital means. Application level Knowledge examples Skills examples Attitudes examples User Guide/Mentor He/She is able to... - have overview of various digital business packages and applications - understand care organisations management processes and procedures - plan care workers schedules and tasks through digital systems and databases - monitor care work performed by others through tracking and reporting tools - administer digital profiles of carer workers and other staff - process digital administrative input submitted by care workers (e.g. reports, work-hours sheets, client requests) - create periodic statistics and overviews of care workers activities - communicate online with related services and bodies such as municipalities, social offices, medical facilities, other care organisations - provide online guidance and supervision to care workers - promote effectiveness and efficiency of care organisations processes - balance digital management with personal and case-specific attitude to care workers 91

92 6. References ALA-MUTKA, K. (2011). Mapping Digital Competence: Towards a Conceptual Understanding. European Commission Joint Research Centre, Institute for Prospective Technological Studies. ALBANESE, M. A.; MEJICANO, G.; MULLAN, G.; et al. (2008). Defining characteristics of educational competencies. In Medical Education 2008, 42: pp CARRETERO, S.; STEWART, J.; CENTENO, C.; et.al. (2012). Can Technology-based Services support Long-term Care Challenges in Home Care? Analysis of Evidence from Social Innovation Good Practices across the EU: CARICT Project Summary Report. European Commission Joint Research Centre, Institute for Prospective Technological Studies. CEDEFOP (2008). The shift to learning outcomes. Conceptual, political and practical developments in Europe. European Centre for the Development of Vocational Training. CEDEFOP (2012). Curriculum reform in Europe. The impact of learning outcomes. European Centre for the Development of Vocational Training. ECDL FOUNDATION (2007). European Computer Driving Licence / International Computer Driving Licence. Syllabus Version 5.0. EUROPEAN PARLIAMENT AND THE COUNCIL (2006). Recommendation 2006/962/EC of the European Parliament and of the Council of 18 December 2006 on key competences for lifelong learning. In Official Journal of the European Union 2006/L 394/ EUROPEAN PARLIAMENT AND THE COUNCIL (2008). Recommendation of the European Parliament and of the Council of 23 April 2008 on the establishment of the European Qualifications Framework for lifelong learning. In Official Journal of the European Union 2008/C 111/ FERRARI, A. (2012). Digital Competence in Practice: An Analysis of Frameworks. European Commission Joint Research Centre, Institute for Prospective Technological Studies. FERRARI, A. (forthcoming). DIGCOMP: A Framework for Developing and Understanding Digital Competence in Europe. European Commission Joint Research Centre, Institute for Prospective Technological Studies. HJALAGER, A-M. (2009). An Ageing Europe: Assistive technology and lifelong learning. 4 Leaf Clover Project. HUSSEY, T.; SMITH, P. (2002). The trouble with learning outcomes. In Active Learning in Higher Education 3, 3: pp KUBITSCHKE, L.; CULLEN, K. (2010). ICT & Ageing. European Study on Users, Markets and Technologies. Final Report. LASSNIGG, L. (2012). Lost in translation : learning outcomes and the governance of education. In Journal of Education and Work 25, 3: pp MARINONI, C.; ROGALLA, I. (2010). Building the e-cf a combination of sound methodology and expert contribution. European e-competence Framework. SCHMIDT, A.; CHIATTI, C.; FRY, G.; et al. (2011). Analysis and Mapping of 52 ICT-based initiatives for caregivers. CARICT Deliverable 2.3. European Centre for Social Welfare Policy and Research. SOUTO-OTERO, M. (2012). Learning Outcomes: good, irrelevant, bad or none of the above? In Journal of Education and Work 25, 3: pp VALENTA, L.; et.al. (2012). Methodology guidelines and tools to collect information on ICT knowledge, skills and competences of domiciliary care workers and caregivers. Carer+ Deliverable 2.1. Confidential. 92

93 VALENTA, L.; PEREZ-GARCIA, M.; SUBA, E.; WARBURTON, S; ZIEGLER, P. (2013). CARER+: Towards a Digital Competence Framework for care workers in domiciliary care. Conference paper; EDEN Annual Conference YOUNG, M.; ALLAIS, S. (2011). The shift to learning outcome based frameworks: Key problems from a critical perspective. In Austrian Open Access Journal of Adult Education 14: pp ZIEGLER, P. (2012). Results of the quantitative analysis of digital/ict skills of care workers and caregivers. Carer+ interim report. 93

94 7. Annexes This section presents full account of the evidence collected through the CARER+ Work Package 2 research activities. The following reports are included below: Reports from the analysis of competence-related documents such as curricula, training programmes, etc. Expert focus groups reports Expert interview reports Analysis of the questionnaire survey on care workers and care givers 94

95 Phase 1: Desk research document analysis Carer+ Report Phase 1: Collection of learning outcome information from open sources Partner organisation: Country: Reporter (+ address): EOS Foundation Romania Cornelia Popescu Learning outcome (Knowledge/skill/competence description translated into English) In Romania, the qualification/occupational standards for different occupations and professions are developed by a range of experts coming from organisations/institutions that are providing Training programmes. Analysis and validation of these standards is done by National Qualifications Authority, Ministry of Education, Research, Youth and Sports and also by the Ministry of Labour Family and Social Protection. The qualification/occupational standards are classified in Romania according the domains and subdomains of activity. The qualification standards refers to training programmes with more than 360 hours of training (Theory and Practice) this type of programmes are grouped on 3 levels: Level 1: 360 hours of training Level 2: 720 hours of training Level 3: 1080 hours of training Type of source (CS; QS; Cu; OS; JA; other) Short descripti on about the situation in Romania regardin g QS and OS Regarding the purpose of the Carer+ research activity the qualification standards that we consulted for our research referred at 2 areas of activity: Information technology, communications, post and Health, hygiene, social services. In our research we identified than the number of qualification courses is much smaller than the initiation/ specialization programmes this is because they have a big number of hours opposed to the last category where the number of hours is smaller and each training provider sets the number of hours for the training program. Also, the courses ending only with participation certificate are fairly required, because the participants have the opportunity to acquire basic information regarding their area of interest. The domain regarding digital competences/information technologies covers especially initiation/ specialization programmes, and less qualification programmes. Introduction, validation and data processing operator QS The person who wants to become "Introduction, validation and data processing operator" must have completed the secondary education and basic knowledge of information technology (hardware, software, models and data structures, data storage media, transmission media information). By completing the specific skills according to occupational standard of "Introduction, validation and data processing operator, a person may qualify 95

96 as text and image processing operator, computer and network operator, programmer assistance. The training programmes Specific digital competences: Managing the introduction and validation of data in electronic format / storage devices / documents Organize his own work Using peripheral equipment Data security / documents security Data introduction and validation Data processing Transcribing data on electronic support Additional activities for supporting electronic data processing, which can be mentioned: Ensuring the compliance of data introduced with the primary documents Saving Periodically the data introduced Restores the saved data needed Recovering data for users at their request Keeps backups of data stored in electronic format. Computer and Network Operator A person who wants to become "Computer and Network Operator" must have secondary education completed and basic knowledge of information technology (hardware, software, models and data structures, data storage media, text and images, transmission media information, networks computers). Specific digital competences: - Ensuring the functioning of computer, computer network - Ensuring security of data and equipment - Assisting users - Computer Maintenance and equipment - Install, configure computer / computer network - Providing the necessary components and consumables Description of the qualification: The "Computer and Network Operator": Ensure a proper functioning of computers, peripheral equipment and access equipment/network interconnection; monitoring the functioning of computers, peripheral equipment and the connection / interconnection network; Install and configure operating systems and applications using standard procedures; seeks proper use of applications by users; Makes available for the users the system resources and/or those of their network; Verify the compliance with security policies access to equipment and data required for system engineers or network administrator; indicates deviations from these rules and contribute to the correction procedures; Assisting users in solving duties involving the use of computers; it corrects the users when they do not meet the standard working procedures; Saves periodically and in critical situations working data of users; restores the saved data when needed and helps users to recover the information. QS %20calculatoare.pdf 96

97 Web design course OS Specific digital competences: Analysing goal web page Designing the site structure Image processing, creating animations and flashes Development of prototypes Making the site Testing the site Publishing the site Site Maintaining Occupation Description: Web designer makes the transfer between the information received from the client, in a particular format, in a manner as close as possible to visitors. Web designer implements marketing knowledge, performs analysis and synthesis to reveal the demands of visitors and customers, has specific skills in information technology and the qualities of an artist in order to model the websites. He manages to combine technical data in an artistic structure as pleasant and functional as possible. Visualization of the informational content for web visitors is made using different browsers such as: Internet Explorer, Netscape, Opera, Mozilla, Conqueror or Firefox. Occupation meets a limited segment of client needs through specialization in a particular area of website design: text, graphics and animation, content, multimedia and interactivity. Operator text and image processing course OS A person who wants to become "Operator processing text, images" must have secondary education completed and basic knowledge of information technology (hardware, software, models and data structures, data storage media, text and images, media information transmission). Specific digital competences included in the occupational standard: - Maintaining the equipment functionality - Securing data / documents - Word processing - Processing of drawings - Image Processing - Static Assembly and/or the dynamic of text/ or drawings and / or images - Making presentations - Translation of work on electronic support. 97

98 Operator text and image processing curriculum Cu EOS Foundation is a non-profit accredited organization that has as main activity the development of ICT training for the wider community but also for disadvantaged groups as: people from rural communities where the access to information is difficult, young people facing social and economic difficulties, people with disabilities. The curriculum for the course Operator text and image processing was developed by EOS under the project Improving quality of human resources in rural areas and encouraging entrepreneurship in non-agricultural activities but also the course was delivered until now for a range of young people coming from the Centre of Social and Professional Integration and those that are living in fosters families. Duration if training:40 hours Objective: Support the person to work with peripherals and to use applications in order to able to process text and images. Key points: 1. Maintain equipment in working order, work with peripherals (the module includes knowledge and skills necessary to maintain functionality peripherals (input - output) and use them effectively to ensure high productivity processing process text and images). Overall objectives of the module: - Arrange peripherals; - Peripherals using input / output; - Maintain processing equipment; - To test the operation of equipment; 2. Text processing - includes the knowledge and skills necessary for text (word) processing - important task of text and image processing operator. During this module the focus is on using a text-word processor to write and investigate a range of personal and business documents, from simple letters and memories to complex documents. Students begin with the drafting and editing of Word documents simple extension to use templates and sophisticated formatting techniques. It treats the problems of design documents, students learn to work with the page margins, indents the paragraph and spacing, tab settings, page numbering, and use the Page Setup headers and footers. Students learn to incorporate graphics into Word documents, add columns and work with tables. 3. Processing designs and images - includes knowledge and skills to build, compose and save the design objects. General objectives of the module: - To process designs; - To select processing program designs. - To select the image processing program; - Take-over, scan, paint pictures; - To process images; - To operate with specific files. 98

99 4. Making presentations basic notion The module includes the knowledge and skills necessary for making presentations for various events, exhibitions, demonstrations, etc. The modules presents everything that students need to know about putting together persuasive electronic presentations, from creating basic slideshows and by adding graphics, animation, sound, and various automatic characteristics. General objectives of the module: - Using presentation tools on a computer - Realization of basic operations such as - Creation, formatting, preparing presentations for distribution and presentation - Making presentations to various audiences and situations - Realization of basic operations with graphics and charts - Use various slide show effects (sequential presentation of images). 5. Securing data/documents - the module includes the knowledge and skills necessary to ensure the safety input data and documents created, primary documents and those obtained after processing by the printer printing, and data storage media and content. General objectives of the module: - To back up the storage media - To ensure data security - Provide antivirus protection - Ensure document security and data storage devices Over 400 of entrepreneurs from rural areas were trained under this programme and also 55 young people from the Centre of Social and Professional Integration and those that are living in fosters families. %20si%20imagine.pdf Fundamental concepts about Internet and World Wide Web EOS Foundation is a non-profit accredited organization that has as main Cu activity the development of ICT training for the wider community but also for disadvantaged. Duration of the program: short program 12 hours The course Fundamental concepts about Internet and World Wide Web presents the exploration of Web pages, using search engines, work with , receiving and sending messages, attaching documents and organize mail folders. At the end of this course, students will have skills related to: Understanding how to use the Internet and search options; Print Web pages and search reports; Use , send and receive messages; Attach documents or files to a message; Organizing folders or directories messages This course was delivered especially to people that are interested to know how to surf on the Internet and for seniors which are interested to use internet for communication and use of the social networks. Introduction to digital media Cu 99

100 Duration of program: short program 10 hours The course "Introduction to digital media" presents to students a wide range of possibilities for using computers and digital media to capture, manipulate and improve music, photos and videos. At the end of this course, students will have basic notions related to: How to use digital photos including choosing a camera How is quality photos How to handle results How to edit and enhance media files using a variety of digital tools for processing How to work with Microsoft Windows Movie Maker to capture video and audio How to import existing digital media files How to edit video and special effects How to save and send videos Cu Conect project The program was implemented through the project Knowledge Based Economy developed by the Romanian Ministry of Communications and Information. The project was developed especially because in the present in our country, on one side the demographic trend is to increase the average age of the community, and on the other hand, technology is present in more and more aspects of daily life and the elderly are a vulnerable group when they are excluded from access to technology. During this program was developed a specific curriculum for seniors so they can be able to use computer. The main target group were the elderly from 4 partner EBC communities and surrounding villages estimated at about 8400 people. Figures reveal that people over 60 are nearly a quarter of some Romanian villages and these data were collected before the massive migration of young people abroad. Curriculum designed for the seniors within the project included 4 modules: 1. Computer components The module contains information about the components of a computer, which is their role, how to use them and also which are the devices that can be connected to a computing device. Also, the participants learned about the difference between hardware and software, how to secure their computer and accounts, which are the input, output and input-output devices. After the presentation of the things mentioned above the seniors learned: How to start and to stop a computer; To use the working area (desktop) how to set up the wallpaper, to use Start bar, to use icons, to create a folder to copy, move, rename, compress, delete and restore a folder; 100

101 2. Internet What is a window, how we move, minimize, maximize a window; How to change the size and shape of a window. Internet concept: what is a modem and an internet provider; Internet navigation: What is a browser and which are the internet browsers that can be used; Working with browsers and basic notion about internet navigation: Navigating using Standard toolbar and keyboard; Printing Web Page; Selecting the search engine; Using the service/electronic post and also chat service; 3. Microsoft Word What is Microsoft Word; Microsoft Word elements: Title bar, Menu bar, Standard toolbar, Formatting toolbar, Scroll bars; Button closing; Insertion point; Entering text; Document saving; Navigating through a document; Text selecting; Deleting and restoring the text in a document; Formatting text; Alignment of the text in a document; Apply styles to text; Thickening, tilting, underlining words; Apply different colours to text; Change document layout; Formatting a paragraph; Change the page orientation; Examination of documents; Insert a picture from a file; Working with tables; Printing a document; Close a document and exit Word. 4. Power Point What is Power Point; Starting the program; Menus and working fonts in Power Point; Saving and modifying a presentation; Creating a presentation - Preparation and design of presentations; Working with Slides - Adding new slides; Change the layout of a slide; Objects slide; Applying a theme to a presentation; Thumbnails, Images, Photo Album; Insert a picture. The course was adapted to the seniors needs by the e-centre Recas manager, one of the e-centres participating in this program. The e-centre Recas is also members of the e-centres network coordinated by EOS a network that gathers over 40 e-centres of public access to information in Romania. Care workers for elderly and children at home Specific skills from the occupational standard for care workers Hygienic care for the assisted person; Assuring the comfort for the old person; Assisting nutrition and food management; Skills development for the assisted children; Mobilization and transport of the old assisted person; Mobilization and transport for the assisted child; Mobilization and transport of the assisted persons which is immobilized; 101

102 Compliance and application of medical prescriptions; Health surveillance of persons assisted. %20domiciliu.pdf Specific skills from the occupational standard for nurse Feeding and hydration of the person cared; Cleaning the space where the person cared is living; Hygiene of the cared person; Transportation of the clothes / sheets in order to be cleaned Transport of cared persons. As we can see the ICT competences are not included in the occupational standards for the qualifications regarding home care in Romania. Comments, any other information: Carer+ Report Phase 1: Collection of learning outcome information from open sources Partner organisation: Country: Reporter (+ address): Learning outcome (Knowledge/skill/competence description translated into English) FEPEM France Céline BEDEL cbedel@fepem.fr Type of source (CS; QS; Cu; OS; JA; other) Identify the needs of older people at home and the solutions offered by technology. Have an understanding of ethic issues (liberty and security) posed by technology. Possess knowledge about the panorama of gerontechnology and about progress of research in France, Canada and Japan. Possess knowledge about handling of innovative materials: fall detection and automation, communication and social relations (TV, computer and phone adapted). Master assessment techniques to identify relevant gerontechnology for home QS 102

103 Develop technical skills related to computers and the Internet. Master the content, processes information and communication, including digital, serving individual projects (or collective): employment, social relations, culture, society, public services, citizenship. Develop human relations within a professional environment through a serious game. Understand the psychological characteristics of elderly OS JA Carer+ Report Phase 1: Collection of learning outcome information from open sources Partner organisation: Country: Reporter (+ address): IFEF - IPERIA France Stéphanie VINCENT stephanie.vincent@iperia.eu Learning outcome (Knowledge/skill/competence description translated into English) Maintain social ties through new technologies Understand new technologies Have control/command of new technologies Support others in the use of new technologies Propose/Suggest activities: send and receive s and photos, do eshopping, subscribe to online forums. To advise on equipment (touchscreen, webcam, ) Discover the Internet Know how to use new technologies. Discover the computer (computer, mouse, USB, CD-ROM...). Use the main features of a web browser Discover how to use s Support children and adults in using the computer Mastering the concepts and basic functions of a computer workstation (organize, customize and manage a computing environment.) Use in a networked environment (connect and identify different types of networks) Adopt a citizen attitude in the information society (know the rules of use and the dangers to networks and data exchanges, rights and obligations relating to the use of computers and the internet ; protect information about him and his data ; take part in the information society in its administrative and civic dimensions). Make digital document (designing a document ; implement the basic functionality of tools for processing text, numbers, images and sound ; achieve and broadcast a composite document). Build a research and evaluate information (access, identify, evaluate and organize information online). Communicate, share, collaborate, network (use a communication tool Type of source (CS; QS; Cu; OS; JA; other) Cu Cu QS 103

104 responsive ; exchange of digital documents ; collaborate network). Take ownership and use a computer (mastering the basic techniques gestures ; know the vocabulary of ICT). Create and use a digital document (create and format a short text and a simple table ; use pictures) Using Internet services (navigate and browse web, search online and use online services). Communicate and exchange on the Internet (use s and tools to real-time dialogue ; publish, share and learn online). Know your rights and the rules of use on the Internet Know the environment of ICT (basic vocabulary, networking, security, legal aspects). Mastering the standard office applications (create and manage documents). Use the online services and communication tools (use s and web browsing, search information, use social networking, e- commerce...). Know to use a computer (mouse, keyboard...). Use a internet browser software (navigation, toolbars...). Be in contact through Internet ( ing, use synchronous communication). Search information online. Be autonomous with a computer (use and manage a computer). Use a internet browser software (navigation, search information...). Produce and exchange documents and images. Communicate online and send with joined document Use online services (use facebook, create an account) Discover the computer and its environment (mouse, keybord...) Discover internet Manage of sending and receving s Know to create a document with Office Microsoft Know to create a picasa account and manage picasa to make an album Learning to learn with peers Identify public digital spaces are spaces for resource use of digital Communicate using digital Find useful information on the internet Internet use for administrative or online shopping Download music, a novel, a newspaper... The digital readout Play online multiplayer Discover innovative online services and adapt them to family use listen to stories to better support the elderly person daily (peer learning). Learn and understand the social, territorial health through the interviews of experts (video). Go to online conferences to better live the illness of a close Learning to use a mobile tool. Learn to use materials, products and services simplify the lives of older people unaccustomed to using technology today. Know the products and services referenced for the elderly. Learning mobility and interactivity with a tablet Know to use basic functions of a tablet (turn on, turn off, connect to wifi, use a digital interface) Kwow to use applications on a tablet (donwload, install, create an account...) QS QS QS Cu Cu Cu Cu Cu 104

105 Create home videos with animoto Create stories and narratives with a shelf life Paint and draw with a tablet Create multimedia presentations with a tablet Listen to music with a tablet Share and exchange with a tablet (peer learning) Learn to learn witn a learning system management Learn to learn with a seriousgame Learn to learn with a socialgame Learn to learn in mobility (smartphones) Learn to learn with peers Comments, any other information: Cu Carer+ Report Phase 1: Collection of learning outcome information from open sources Partner organisation: Country: Reporter (+ address): ISTITUTO PER LA RICERCA SOCIALE ITALY Francesca Di Concetto (fdiconcetto@irsonline.it) Learning outcome (knowledge/skill/competence description translated into English) Knowledge of ICT tools for data recording and/or transmission Basic ICT and internet Comments, any other information: Type of source (CS; QS; Cu; OS; JA; other) QS Other (course for caregivers) Training policy in Italy is entrusted to Regional governments; the terms and content of training programmes for caregivers are defined by regional decrees and specific guidelines. The Emilia-Romagna regional government designed a training path divided into three subject areas: institutional, relational, and technical-operational. Courses for caregivers are provided by regionally accredited training providers (list of accredited providers available in the websites of the Regional administrations - Training courses provided by accredited providers are formally recognized by the Regions. Courses are mainly funded by expressly allocated national funds or by the ESF, and are free of charge for the trainees. The contents of the courses must comply with those defined at regional level (see above). Training courses for caregivers play a significant role in the regulation of the private 105

106 homecare services market though Emilia-Romagna (like several other regions in Italy) has not yet included a formal Caregiver qualification in its RQF. However, regional regulations mention a number of skills relevant to caregiving, which can be certified through a declaration of competence. 8 This allows credit recognition for access to further training aimed at achieving the Healthcare Assistant 9 qualification, which is the only qualification in the RQF Health and welfare services area - connected with the provision of home care services (the others being: Social Animation Operator, Thermal Spa Operator, Sign Language Interpreter, Intercultural Mediator, Dental Assistant). As regards ICT/digital competences, the Healthcare Assistant Qualification Standard does not mention any particular skill except Knowledge of ICT tools for data recording and/or transmission (reported above). On the other hand, some courses for caregivers (not leading to a qualification but to a declaration of competences as detailed above) include, besides the 3 mandatory subject areas, further training modules, among them also basic ICT and internet modules. Carer+ Report Phase 1: Collection of learning outcome information from open sources Partner organisation: LIKTA ( Latvian information and communication technology association ) Samaritan Association of Latvia, Country: Latvia Reporter (+ martins.etkins@samariesi.lv, Mara.j@dtmedia.lv, address): Learning outcome Type of (knowledge/skill/competence description translated into English) source (CS; QS; Cu; OS; JA; 8 A declaration of competence is a non-official certificate that can be issued either by the Regional Government or by the Training Provider at the end of an internship or a training course. It does not require the passing of an official exam. A declaration of competences usually contains the following information: type of training (course, internship, etc.); entrance requirements skills acquired by the trainee (basic skills, technical/professional skills, transversal skills) start date, end date, and duration of the training skills testing modalities. The declaration of competences certifies the single skills actually acquired by the trainee. It can be issued also to trainees who have not completed the training course since it only certifies the skills acquired by the trainee as of the moment when the declaration is issued. 9 (Operatore Socio-Sanitario, in Italian). 106

107 1.University of Latvia, P.Stradiņa Medicine college "Social carer" - 1.level higher education professional program 2 years full time (80 credit points/ 120 ECTS) Accredited and licensed till Qualification - social carer Professional standard - social carer Knowledge : Skills: apply latest Digital Technologies in care work other) QS, OS ICT skills : program includes a course Information Technologies/Electronic resources 80 academic hours, 2 credit points. Students learn general knowledge working with computer, text editing, spreadsheets, presentation software (MS Office, Word, Excel, PowerPoint) 2. Liepāja University "Social carer" - 1.level higher education professional program 2 years full time (80 credit points/ 120 ECTS) or 2,5 years part time studies. Accredited and licensed till Qualification - social carer Professional standard - social carer OS QS, ICT skills : includes 80 academic hours ( 2 credit points ) course Computer Technologies 1. How to use the most popular ICT systems 2. Professional use of MS Office programmes ( Word, excel, PowerPoint ) Computer skills as a tool for management and administration 3. Daugavpils Medical college "Social carer" - 1.level higher education professional program 2 years full time (80 credit points/ 120 ECTS) Accredited and licensed till Qualification - social carer Professional standard - social carer OS QS, ICT skills : includes 40 hours ( 1 credit point ) course Informatics and data processing. Students learn genera ICT skills, basic skills to work with Internet search engines, text editing, electronic spreadsheets and databases. (MS Office, Word, Excel, Access) 4. Higher school of MANAGEMENT and SOCIAL WORK Attistiba "Social carer" - 1.level higher education professional program 2 years full time or 2,5 years half time (80 credit points/ 120 ECTS) OS QS, 107

108 ICT skills: doesn t include special ICT skills training. 5. Alsviķu vocational school "Social Care" vocational study program, 3 years Accredited and licensed till Qualification carer, 2nd level Professional education OS ICT skills: doesn t include special ICT skills training. 6. Austrumvidzeme private training centre Social care" further professional education study program, 480 hours Accredited and licensed till Qualification carer, 2nd level Professional education OS ICT skills: includes course Computer skills 32 hours 7. Center of Professional Education, Further Education and Examination (PITEC) Basics of social care work" Program of Professional development 160 hours Accredited and licensed till Qualification care worker CS ICT skills: includes training how to work with MS office software and how to use for care work administration. 8. The Local Government Training Centre of Latvia Carer" further professional education study program, 480 hours Accredited and licensed till Qualification carer, 2nd level Professional education QS ICT skills: doesn t include special ICT skills training.!!! Besides we have 8 more different training (further education) programs and courses for carers, care givers and care workers in Latvia. Starting from 8 up to 480 hours, none of them includes any requirements or training of ICT skills. 108

109 Phase 2: Expert focus groups Carer+ Report Phase 2: Focus group session transcript Partner organisation: Country: Reporter (+ address): 3s Unternehmensberatung Austria Date of session: Place: Mariya Dzhengozova Vienna Duration: 02:10:00 Number of participants: 9 State of the art: what IT solutions and skills are currently used? (P9): Currently, the demand and supply in the IT field for care receivers is reduced to emergency phones with extended functions. These are available through the care service providers, who ensure technical support as well. With the increase of IT supply, service providers could not always ensure technical support. Therefore, caregivers and care workers will increasingly take charge of the basic configuration of IT devices. For the moment I do not see any shortages, but they will come to us soon. (P7): Several federal provinces track care work activities via mobile or smart phones; to be able to deal with these devices is the knowledge required from careworkers. Furthermore, staff planning is now based on electronic systems, which requires elementary computer knowledge. There is an intention to put into operation the electronic care documentation and care assessment help, but in my opinion in 5 years the professional health and nursing staff will all use e-tablets (for capturing data on the clients health care status). (P4): As a CIO at Haus der Barmherzigkeit, I was responsible for the introduction of electronic care documentation system, where IT should be a daily tool for all nursing staff. That was a very challenging task as it turned out that in general the nursing staff had very low IT skills a significant part from the employees were not from Austria, but from Poland, Slovakia, Slovenia, partly from India and the Philippines. Some of them have not worked with a computer and were afraid of touching the mouse. We carried out trainings, which aimed to reduce the insecurity and fear in dealing with IT as well as to provide some elementary IT skills. The target group was between persons and all of them went through a specific training on the electronic care documentation. Only ¼ of the target group took part in the general IT training (use of Thin-Clients, basic functions of Windows including standard applications such as open, save print ). Without these trainings, the introduction of the electronic care documentation system would not have been possible. Compared with the stationary care, the mobile care is with one step further in applying IT solutions (mostly due to the use of mobile and smart phones). (P6): Since 2007, the professionally qualified health and nursing staff of Wiener Sozialdienste uses a computer for keeping track of activities and documentation. For two 109

110 years now, we have been working on the implementation of electronic care documentation and we expect that we can put it into operation soon. (P9): We should differentiate between use of ICT for internal organisational purposes, use of ICT in direct interaction with care receivers (or by care receivers themselves) and use of ICT devices, specifically set up in households (AAL solutions). (P1): In Sozial-Globial, we have not already introduced the electronic care documentation, but we are on the way to do so. We use mobile data capturing and emergency phones. In the daily practice, careworkers use IT skills in confirming/signing that a service has taken place. All our employees (independent from their qualification) have learnt to deal with these mobile phones and our clients to sign per handy. (P2): I will focus on another point the involvement of caregivers (i.e. IT access to information concerning their family members or trainings on how to communicate emergencies via IT-based devices) is very limited for the moment; at least I do not know of any practices, projects, activities encouraging this involvement. However, I expect that this will change in the future. (P8): But I think that due to the age of caregivers, they should have already experience with IT. As for the health and nursing professionals, according to a survey of the Austrian Health Institute (ÖBIG) 10, they remain in the occupation for approximately 12.4 years on the average, which means that they are quite young. This gives to some extent a guarantee that care workers are familiar with the use of IT in general. (P3): The issue about the involvement of caregivers is quite important. In Austria we are now in the pilot phase i.e. there are already projects, which aim to improve the networking between caregivers and care service providers (for example, in dealing with stress situations) as well as to encourage the involvement of care receivers. The need of such projects is enormous care service providers acknowledge the role of caregivers, however, so far there are no established structures and routines for mutual interaction and information exchange. (P5): What we do in Living lab in Schwechat 11 is to try out research projects and create 10 Österreichisches Bundesinstitut im Gesundheitswesen, The city of Schwechat is committed to act as "Living Lab" i.e. local authorities, social care providers, elderly persons, caregivers, research entities and companies are cooperating closely in order to invent, discuss, explore, implement, and evaluate new technologies supporting the quality of life and the independent living of senior citizens. CEIT RALTEC involves elderly persons and caregivers in its research activities based on a participatory design approach,

111 prototypes for IT solutions, for example development of special icons or user interfaces tailored according to the needs of care receivers. In this context, the involvement of care receivers is crucial. Our experience from small-scale studies with tablet PCs shows that older people who have no experience with PCs, internet and/or IT become familiar with it very quickly after receiving a basic training. (P1): We have to differentiate between older people, interested in ICT solutions and other who are not. From our practice (Sozial-Global), we know that it is very important to involve care receivers in the selection of features and IT solutions and to respect their individual wish. Crucial is also the availability of contact persons responsible for technical questions or the introduction of basic trainings for care receivers. (P9): A small illustration... Fifteen years ago, TU Wien had to develop a smart room for a special needs school in Tirol. Within the project called Autonomous (Autonom) we differentiated three key roles i.e. the technical staff, which has to create the necessary structure, the end users (older people or people with special needs) and the health, nursing and teaching staff. For all three groups we have developed completely different access to ICT. The technical staff had its technical interfaces; people with special needs used a special button. For the teaching staff we have created a simplified configuration tool, which they could use after simple one-hour training. The project has given good results and has been the basis of many of our current activities. (P2): The introduction of training, the existence of a concrete contact person as well as the existence of individual network (building up of users self-support groups) are important for the applicability of such projects. In this context, care workers who act as primary contact persons have also an intermediate role, for example, in giving their opinion on what is good or useful IT solution for the care receiver. What IT skills should integrate a competence framework for care workers? (P4): May be we should firstly define what are IT skills and what kind of IT skills need these three groups - careworkers, caregivers and care receivers... (P9): One should not define the term ICT very narrowly what is a TV? What is a TV today and what will be a TV tomorrow? In my opinion, it is an ICT skill to be able to adjust a TV for the needs of an older person (selecting for example the five most important channels) or to be able to set the directory with relatives in the fixed phone. These things should be in the competence of a complementary care service, which goes beyond medical care and includes personal well-being. (P1): I do not think that that should be a task of the care worker. Another occupational group should be responsible for adjusting new technologies according to the needs of care receivers. (P7): One should differentiate between formal and informal care. The tasks of a professionally qualified health and nursing staff are different from the tasks of caregivers. However, the field of elderly care services is broader - apart from professionally qualified health and nursing staff, it includes a grey area, for example, the 24-hours care assistance. 111

112 According to the Austrian law, people working in this area are not professionals; but they are not caregivers as well. This grey area represents actually the level between formal and informal care. (P3): Let me go back to the central question: what ICT skills should have care workers. A very basic requirement is not to be afraid of dealing with ICT-based devices. The biggest challenge here is for the developers of user interfaces, as they have to adapt them according to the user needs. (P2): It is very difficult to use IT-based devices when there is no basic understanding of the problematic of IT-solutions, which are partly very formal and require precision and accuracy (i.e. in terms of time parameters). Working with an IT solution for documentation purposes, for example, is different from working with paper. (P9): The IT system developer should pose him/herself the question what kind of basic understanding could I require from the user of this or that IT solution. (P7): E-tablet is the simplest device that care workers could use. E-tablet is simpler than a TV. We (Hilfswerk Österreich) require from our home assistants that they know how to use a washing machine, vacuum cleaner, dishwasher, etc. we do not require knowledge in computer operating systems. What should be the basic IT skills for 24-hours care attendance at home? (P1): The 24-hours care attendance is not the most relevant group among care workers where we have to require IT skills. A significant part of the employees are not Austrian and do not know the Austrian health system. Additionally, many of them do not speak German, which complicates communication in emergencies. (P7): The use of a mobile phone with integrated language translator could be a solution, but it requires some computer literacy in writing. Back to the central question: What IT skills should be included into the competence matrix? (P8): In legal terms, care workers can use only the devices they have been trained to use; therefore, their IT skills will depend very much on the kind of devices they apply. (P7): We have to differentiate between three different application areas. In the stationary area will be established the care documentation and diagnosis, the assistive technologies will gain on importance, which requires that care workers could give a feedback, know how to read and scan information though the use of IT based devices. Secondly, the role of IT technologies in the provision of care and attendance service as such will become more important. Thirdly, the use of security systems at home (i.e. smart homes) will increase. (P3): But I think that the focus should not be on the IT skills of care workers, but on their working conditions i.e. the applicability of IT devices. In this context, the employer should 112

113 ensure training for the employees. If care workers accept the IT solutions and have the necessary knowledge to deal with them properly that should be enough. (P2): Important here is the clear role definition of care service provider, IT-technician, physiotherapist and the intermediate role of care workers. Care workers do not need to have a technical overview, but a contact person among the technicians. In this context, central IT skill for the care workers is to know how to deal with the data they receive how to arrange it, set out priorities, understand what does it mean and take decisions correspondingly. (P3): Care workers at the management level have IT skills, however, that is not required for those care workers who actually provide the care service. What should be the minimum of IT skills that care workers should have? (P8): If care workers have to use a system as an assessment instrument, this requires quite solid IT competences not only to feed the system with data, but also to assess the data. (P5): Technologies should facilitate the work of people they should be for people and not vice versa people should not be for technologies. Care workers should interpret the data at a glance and that is the meaning of IT solutions simplification. (P4): If care workers know how to measure properly blood pressure, for example, the device should be so simple that care workers should not need a training to use it. The only condition is not to have fear in touching and dealing with technologies (which is almost an IT skill). (P9): We are currently working on smart home equipment that is able to recognise emergencies giving automatically an alarm signal. For a sensor-equipped household it is typical to capture certain parameters for standard situations, however, it cannot distinguish when and what is an emergency. For example, if a person wakes up after 10 am, there is something wrong, if a person goes to the toilette at night and doesn t come back within x minutes, there is something wrong. Who defines these values? How much time do we need for going to the toilette at night? Is it an IT skill to be able to respond to a question asked by the system? If we define the parameters of the system according to the personal case, it is unrealistic and very expensive to contact the producer for each individual case. What are the big obstacles, challenges? (P6): We (Wiener Sozialdienste) are now in the process of introducing the electronic care documentation and as far as I know, some of the employees have fear from the additional effort it may require, although, the system should actually save efforts by replacing the paper work. For keeping track of working hours and activity reporting, we provided all employees including home care assistants with personal digital assistant (PDAs). Dealing with the device was a challenge for staff above 50+. However, I was surprised of the acceptance nobody has rejected to use the devices. (P7): Through the introduction of care documentation systems, monitoring of working 113

114 hours and activities will be more precise and that may have an effect on the acceptance of new technologies among care workers (the feeling of being monitored). However, on the other hand, the use of modern devices adds value to the occupation and this has a positive effect on the acceptance of these new technologies. Is it a task or an important competence of a care worker to recognise the most suitable IT solution for a care receiver? (P2): It is beyond the scope of care workers to take care of that. It implicates to have an overview on the current market of IT solutions. What care workers can do is to provide a contact (from the care service organisation), who could give an advice. Such mediator role i.e. a person who links the care receiver to providers of IT solutions is currently missing. (P8): The professional health and nursing staff protect their old people. If they consider a specific IT solution as a good one, they will recommend it to the older people they are in charge of, for example, systems for fall prevention. (P1): The institution providing care services should select IT solutions and care workers could inform care receivers about these solutions. However, it is unrealistic to require from care workers to have knowledge about the most suitable IT solution. (P9): Important competence of care workers is to be able and self-confident to criticise and/or give a feedback to IT providers on IT-solutions. This ability should be the outcome of a basic ICT training, which care workers receive. What should care workers be aware of in terms of ethics? (monitoring of care receivers in the context of AAL solutions, dealing with personal information s, etc.)? (P3): AAL solutions do not mean 24 hours monitoring, the establishment of AAL apartments in the context of research projects, for example, is possible only through the signature of the care receiver, confirming his/her consent to live in this AAL apartment. Furthermore, the person can step out of the project in any moment. (P5): This concerns however research projects... the situation is different if I want to use an AAL solution as a care receiver or as a family member or a care worker. One should take into account: what does the care receiver want, how could we understand this wish (for example, in the case of care receivers with dementia) and what legal requirements are applicable in the concrete situation. (P8): Professional health and nurse staff learn the ethical dimension of care in the course of their education. 114

115 Carer+ Report Phase 2: Focus group session transcript Partner organisation: Arcola Research Country: UK Reporter (+ address): Damian Hayward Date of session: 01/11/12 Place: NATIONAL HOMECARE COUNCIL - SCOTTISH CONFERENCE held at COSLA, Verity House, Haymarket Yards Edinburgh. DH attends conference and conducts a series of interviews with delegates and speakers as well as running a short lunchtime focus group with 3 key speakers at the event: Veronica Jackson NHC Chair Alexis Jay - Chief Social Work Advisor to the Scottish Government Martin McGeady - Head of Home Care, WHSC Trust Northern Ireland Martin McGeady also interviewed at length separately and gave presentation at the event; see separate template Duration: 30 minutes + scheduling and preamble/introduction by DH. Number of participants: 3 (a number of other delegates are also interviewed briefly at various times throughout the day during which carer + topics are discussed). For further details on conference agenda, delegates, speakers and presentation, please request same from DH. Summary of the session outcomes: (You may use the codes P1 to P10 corresponding to A2.2.2a instead of full names to refer to individual participants. Extend one page if needed.) The following topics were discussed: Topic 1: The current situation involving the use of ICTs in care work and care giving Main Question: How are technologies used now in care provision for older people living 115

116 at home? Sub questions: What kinds of technologies are used and what are they used for? What is the current level of use of ICTs? (how many care workers and care givers use ICTs in their work? how often are they used?) What skills are needed to use ICTs in care work? In what ways do care receivers use ICTs? Topic 2: The future: new opportunities for ICTs Main question: How could ICT be further used to support both care workers in their work and care receivers in their daily lives? Sub questions: Are there elements of home care provision in which ICTs are currently not used, but which could benefit from the use of ICTs in the future? What would be needed to introduce ICTs in these areas? Are there any problems and challenges that would need to be addressed to make this possible? Topic 3: The digital competences required Main question: What new digital skills will be needed for care workers and care givers? Sub questions: What are the current gaps in care workers digital skills? What are the current gaps in care receivers digital skills? What specific competences should be included in a digital competence framework for care workers? Should there be a different framework developed for informal care givers? what would be the differences between this and a framework for professional care workers? The session was recorded. Topic 1: The current situation involving the use of ICTs in care work and care giving P1 stated that each council is individual with respect to degree of ICT implementation in health provision. For example in Oldham Council they had a lot; covering day to day care, reablement and so on. They had a smart house and a demo site in the day centre and a one stop drop-in shop. It is a requirement for the councils to take into consideration the telecare requirements or funds may not be forthcoming. Difficulties included some staff reluctance to use ICTs and some of the less routine uses of ICTs Service users were generally happy to adopt technologies as they promote independence etc Some technologies were not as successful eg digipens were tested in Oldham but they did not catch on. With regard to functionality and whether things are appropriate and if they work it is 116

117 necessary to work with providers and that is what happens. P2 mentions Kevin Doughty from York University who knows much about telehealth and telecare and is regularly involved at all levels regarding use of these technologies in the healthcare and home care sectors. 'In Scotland telemedicine has really taken off because it targets users in remote communities.' There was an Institute for Telesystems promoting the use of virtual consultations etc. The Scottish Centre for Telehealth and Telecare was run from Aberdeen university by James Ferguson the head of telemedicine; see php P2 states that the Kent model is interesting too, using telehealth and telecare which included vital signs monitoring, users could check blood pressure etc. Far from being unusual and sparsely used, these technologies are straightforward and widespread and have been in use for many years. They are becoming more and more widespread and the cost is less and less as time goes by. P2 later comments that she has considerable experience working in EU projects and says, on the subject of the accessibility of technologies that Eastern Europeans manufacturers are now in a position where they can effectively skip a whole generation of development and do things more efficiently and more cheaply 'which is unusual in these times.' (Note the emphasis of much of the discussion at the conference was on austerity and the need for saving money in the health care sector) All participants felt that much of the technology being used in home care is straightforward and mainstreamed. P3 reiterates this also during later phone interview conducted some days after NHC conference. P2 says that West Lothian Council (David Kelly leader) put technology in the home, promoting use for the care receivers themselves. The council (and many others) is also working with dementia sufferers and people with learning difficulties. There are lots of assistive technologies about. Every council has an element of ICT/telecare in its home care provision. All participants in agreement on this. Day to day stuff: web based assessments are simple, booking respite etc all done by care receivers themselves. With respect to the relative cost of bespoke systems (rather than ubiquitous technological devices and solutions) P1 and P2 both state that they are not always expensive when compared to the cost of visits. Vital signs monitoring equipment for example reached low price of 800 a unit which is cheap compared to visits. P3 later discusses the use of assistive technologies in the home and the fact that once the systems are in place and programmed by 117

118 the suppliers they run themselves with very little further involvement by the care provision staff. Other devices such as sensors that go on doors, fridge, bed etc are widely used and have been for years. West Lothian Council undertook a study and costed these tracking devices against the cost of home care visits and they proved to be much cheaper than the typical 20 an hour for daytime care and at night for carers. One example is that P1's former council used to do toilet runs in a van; these are done today using using a response necklace and the service reached its target of getting to the care receiver within fifteen minutes; often much less when compared to some hospital patients who sometimes have to wait considerable lengths of time before they are attended to. There are a variety of origins for technologies today that have become known as smart technologies. The Return to Community programme for people with learning disabilities identified areas and technologies which were useful in its work such as the need to learn to use speaking clock and so on. P2 once again mentions Kevin Doughty who knows a great deal about assistive technologies. P1 observes that it is not all just about young social workers; and suggests asking Lynne McKnight about it; she has a good deal of operational knowledge of working with a wide agerange of care workers. Contact details for Lynne McKnight can be found on the list of delegates. The technologies are easy and there are few problems with people managing or learning them. Easy technologies include the 'fit' blanket which is fitted to bed and sends info to a service switchboard where incident can be reported and reacted to are widely used in home care. 4 people per control centre is given as one example; not expensive; not huge. P2 says that the secret is to work closely with the providers; one of best is Tunstall aids (David Kelly worked for the company) see The company supplies products like Lifeline Vi (similar to devices being piloted in Carer+) Topic 2: The future: new opportunities for ICTs Capital investment in technologies would further support work undertaken by care workers and care receivers in their daily lives. P1 and P2 mention several examples such as: 118

119 North West - the Stockport model - Ian Skelton; Manchester is also good and ICT supports care work well in this region; Kent had a combined telecentre in 2006; and Paul Cassidy in Oldham is another person who could provide further insights into how ICT is currently being used in Home care and how it can be applied in the future. As far as introductions of new technologies are concerned, there are new ideas coming out all the time - Tunstall is very active in this respect and home care providers talk to them all the time about their requirements etc. Once again P2 states that Kevin Doughty at York University is the man to talk to as he knows all about the different assistive technologies in use and in the pipeline. Topic 3: The digital competences required All the local authorities have training and development plans and resources are placed where they are required after due consideration of the needs involved. The councils then try to shape the workforce to the requirements; by training programmes and so on. There is a fund in Scotland for this. SSSC is the regulator of the workforce and registration is not only applicable to social workers but also care workers. See SSSC is 'responsible for registering people who work in social services and regulating their education and training' (Anna Fowley is the key contact at SSSC) There is a move to have all home care workers registered during the period between 2017 and They are working on this now. As far as the care receivers are concerned the situation is easy and they always get training in the use of the devices and technologies used in their care. P2 says the great thing about much of the devices in use in the home is that kit can be moved around. There is a lot going on and the participants mention a number of initiatives like centres for refurbishing older equipment and so on. Age Concern active in this field and U3A also: See and Comments, any other information: Participants are all speakers at the NHC conference and provided helpful references. Martin McGeady is interviewed later during the day and a week later by phone. 119

120 Notes can be provided on request 120

121 Carer+ Report Phase 2: Focus group session transcript Partner organisation: EOS Country: Reporter (+ address): EOS Educating for an Open Society Romania Date of session: 27 September 2012 Place: Duration: Number of participants: 10 Cornelia Popescu Timisoara 2 hours Summary of the session outcomes: Participants of the workshop P1 Marius Milla EOS Foundation P2 Mariș Andra - Maltez Relief Service in Romania P3 Blaj Cristina Caritas Federation P4 Lukacs Ingrid Caritas Federation P5 Paul Lidia Blythswood Association P6 Feier Valerica City Hall Jimbolia P7 Pop Adela Mariana - Home for elderly Jimbolia P8 Borghoff Teodora - independent consultant and expert in Community development and social policies. P9 Popa Adrian - Blythswood Association P10 Gabriela Barna EOS Foundation - presentation of context and main objectives of the Carer+ project and also the structure of focus group. The focus group was attended by 10 participants, participants coming from different areas of interest as: digital inclusion, social inclusion, and also from the field of providing care and services for older people. The focus group included three major questions and each participant was invited to respond to each question per row in order to avoid that certain participants do not express their opinions during the focus group. Of course, if one of the participants did not want to respond of one of the questions this wasn t a problem. The first main question that was addressed during the focus group was related to: Which is the current situation in Romania regarding digital competences and Information and communication technology in home care work? To this main question other additional and helpful questions were addressed, so the participants can identify better the proper answer. To what extent ICT is used in the care field in our country? If ICT is not used in this field which are the main obstacles and reasons leading to this? Which are the main gaps that make that new technology not to be used by carers? Which are the digital skills needed and used by care workers and caregivers? 121

122 P8 - In our country the situation is quite serious starting from the fact that there are fewer home care services and few communities where these services are operating. These services are mostly run by non-governmental organizations, which starting 2007, when the flexible funding s from the social area disappeared and entered the Structural Funds, they have serious problems. Many social profile organizations who tried to run European programs are failing due to the fact that they could not afford to take these projects until the end. Using ICT in care services is a good opportunity, the real problem is that in our country we don t really have good care services, and were we have this services they hardly survive in the communities. P7 In Romania, at this moment digital skills in the care sector are quite low and the main obstacle that leads to this is the lack of funds in this area. There are no funds for equipment s that can be used by care workers in their care work, devices that can meet their training needs in ICT. Also, rarely can be found sponsors to donate new generation equipment to institutions and organizations providing home care services. Older people do not know how to use new generation equipment because they didn t have access to this but primarily as a result of their poor health that many of them have. This equipment s should be as well adapted to the elderly needs and should be kept in minds which are the most common health problems / disabilities that they have. P1 as a person involved in this project that will provide IT training for care workers and as a resource person who will install the equipment at home for the elderly people, I can say that things will be complicated for us, the experts who will implement the project. In order that this devices to be easy to use by elderly and by care workers, we will equip these devices with the most useful applications dedicated to seniors but also with applications that will facilitate the work of care workers and caregivers. Life quality of older people can be significantly improved by using a computer, as well as care workers work that can be more efficient using technology. It should be taken into consideration the fact that the beneficiaries have and social and affectivity needs, not just basic care needs. IT is very useful for them, more useful than TV. P7 In home care work in our country, generally we met women with age around 40 without skills to use a computer. Therefore, it would be helpful to follow a course to learn how to use IT equipment, how to interact with elder person in order to determine him to accept a new thing, accept to use the equipment / tablet and make him understand the usefulness of these equipment and how much it will help him in the future. P6 - Digital skills are based on the age of carers. Of course, most of the young care workers are familiar with new technologies. ICT skills are less common among carers with age over 50 years. Even if their number is small, there are a few care workers that are using new technologies in their care work: using the Internet to search care techniques for elderly, ordering everyday tasks using programs such as Word or Excel. 122

123 P5 - Information technology is useful in care work for seeking information s that will help care worker to establish specific activities for seniors, activities intended to help older people to be more active. Most of the information about elderly care can be found on the internet because in our country there are very few publications regarding the area of older people. That is why, the internet remains the main source of information, and here you can explore many things that are being implemented in other countries, where the area which is dedicated to elderly people is very developed. Older people need besides the basic services (cleaning, shopping), to be engaged at their homes in activities that improve their quality of life, and this can be achieved by using new technologies where they can find things of interest related to their age. P6 In our country it is a little lack of interest regarding the use of ICT in home care sector. It should be paid more attention to home care services and to be allocated a budget for the purchase of equipment and training in the use of new technologies for care workers. Many carers do not use technology because they have not had the opportunity to access it and because the institutions within they work didn t organised ICT courses for them. Those who have minimal computer use skills acquired them individually through non-formal means, being interested in this field. The development of these skills depends on the financial situation of carers. Those who have a better financial situation can afford to purchase IT equipment s and they are trying to learn alone or with the relatives to use them. In Romania, the home care area is very new, there are very few services and often is used as an alternative the institutionalization of the elderly person. Because of that, many care workers are not very well qualified and this leads to a non-use of new technologies. P9 In Romania, home care services are at the beginning. Few NGO s/ local public authorities developed this type of services for the older persons, and the resources are not the only reason. ICT technology is used in home care services in our country - depending on the institution that is providing home care services and its employees. I suppose there are medium digital competences (text editing, spreadsheets, s, smart phones) among social workers, but not necessarily among care workers without higher education. Most of the home care services are addressed anyway to the basic social needs, for survival (e.g., cleaning and food), for which ICT is not (or is not seen as) essential. Reasons for not using ICT in care home field are from my experience: lack of equipment and/or non-familiarity with their use, acquisition costs for the cutting edge equipment s and / or use of the Internet); reasons for targeting the basic needs (cleaning and feeding) in home care for the elderly; Related to the absence of some integrated services (including supplies, counseling and medical home care). The last 2 mentioned aspects supports better the use of ICT for home care services, meaning that supply can be made and online, counseling may include ICT training elements and application of this knowledge in areas such as hobbies, passions, personal and medical interest issues; medical assistance could also incorporate remote monitoring and therapy through ICTs. 123

124 The main gaps that leads to the fact that care workers don t use ICT are: material resources, knowledge, lack of interest, age (when care workers are closer to the age of their beneficiaries), gender (women usually have less time than men giving the fact that they need to care and their own families). P4 - Information technology is essential for any care worker. Using an Internetconnected device they can provide better care services such as: checking the prospects for the medicines that their beneficiaries are receiving, development of sheets and tables where are recorded the basic information about care recipients - medical situation, which are the activities cared at their home. Generally, the elderly from our country do not trust people they do not know, so I think it is very important that the care worker to know how to deal with the care recipient in order to accept in the first place home care services and just after that to convince him to use a computer or other device. The most important ICT skill that a care worker must have is to access the Internet to search for information. Is most useful skill and most often used by them in their work. P2 From my experience in this field, I can say that care workers are using hardly the digital technology because the time allocated to home care is limited and during this time have to covered basic needs: cleaning, shopping, paying bills or taking medication. All the forms, tables and program with the activities that have to be conducted are realized by the social worker based on the information provided by care workers. One of the biggest problems that make technology not to be used in the home care work is that the number of care workers is very low compared with the number of beneficiaries that need these services. Therefore, it is very difficult for them to introduce new activities into daily tasks. P3 It would be very useful for care workers to have a minimal training in new technologies to be able to use computer and internet. This would lead to an efficiency of their work and in this way they are gaining more time that can be used to interact more with care recipients and to achieve and other type of activities such as the use of an technological equipment. With the aid of a device connected to internet the care recipients can relate and with other people as their children and relatives that are abroad. Question no. 2 - How could ICT be further used to support both care workers in their work and care receivers in their daily lives? P9 - ICT should be naturally integrated in services that support this opening. Care workers should see in ICT an alternative (much better/ more efficient) to do the same activities. Probably the counselling services are the most opened to integrate ICT. Care workers can help and guide beneficiaries so they can acquire ICT knowledge and to increase their financial autonomy (e.g., by administering an online payment account). What could be the other alternative scenarios that would lead to the use of these technologies? Subsidies and/or timing for the acquisition of new technology for older people, providing equipment as a loan, grouping several users on a single device, directing the telecentres to 124

125 offer their services to the older people, so they can have access to new technology despite their age. P8 - digital literacy of elderly is really a challenge. In my opinion, so that care workers to use information technology in their home care work, and to have good results, they must first identify current needs and interests of older people to see the things that concerns them and are relevant for their reality. It must be an exploration process between care worker and care recipient that will take a while but finally will lead to the establishment of closer ties between them. We can speak about 2 roles the first one is the substitute role - the beneficiaries learn how to search alone and to solve part of their activities with the aid of technology and the second one, is to improve the relationship between care workers and care recipients by spending time together in order to teach the elderly how to use IT equipment or pointing out things of interest for him, care workers know better the wishes and the interest of cared persons. Use of technology by care workers helps them to know more people working in the home care work and keep in touch with them to share their experiences related to this field. To form a network of care workers where they can exchange ideas and find answers to many problems, is also very important. P7 - Greater use of ICT resources can make the transition from the basic care aspects to services that can provide psychological comfort for care recipients. Carers should be able to access the Internet (services such as Messenger, Skype), and the Office suite: particularly Word and Excel. P5 - Must be identified their interest: e.g. they can talk to colleagues about problems of their beneficiaries and after the work hours if they have the time to do that, by using Skype or Messenger. Can do shopping list using text writing applications, can make a statistic with the tasks for the following days and in this way they can follow easier the tasks that are not yet completed. In the present they write notes about what they have to do, but there is a risk that these notes thereby be lost or forgotten somewhere given the big number of tasks that they have each day. P10 - new technologies can be used to obtain information more easily and to be in touch with other professionals in the field about specific problems encountered in the care work field. What solutions were found by other professionals related to this problem? There are a lot of forums dedicated to these topics, so they have the opportunity to be very well informed. Beneficiaries may also be motivated to use technology by identifying things that make them happy: favourite recipes, famous places in our country for those who may not have had the opportunity to go on holidays in their youth, use the Internet to talk with the relatives who are gone away - the emotional side is the best solution to convince the care recipient to use technology. P5 -Technology helps a lot when it is used and when we have operating equipment s. The opportunity to have always with you mobile IT equipment that can be used give you the 125

126 chance to search immediately the solution for the problems appeared on the field, without the necessity to wait until the next day to be able to give an answer. P3 Because we are talking about a new field, I believe that it will be a little bit complicated just at the beginning until when both carers and older people will understand these concepts related to information technology and its use. They must have contact with these concepts and equipment to realise that it is not impossible or very difficult to use. Their reluctance is due to the fact that they have never been encouraged to use technology to its true capacity. P4 - As a care worker, you must be confident in your own forces and you first have to acquire all the necessary ICT skills so then you can pass them to elderly. Also, patience is an essential quality to be successful on this issue. Care recipient should know that the care worker will support him step by step to acquire knowledge of computer use or that will show him the benefits of technology and what it can found out with the aid of the computer. P2 - Elderly usually are afraid to use the latest technology equipment because they are afraid that they will broke them becoming unusable. They often show a special care to this equipment because they know that these devices are expensive, which makes them reluctant to use them. P1 - The elderly are generally attached of care workers. Therefore, a way to convince older people to use technology is to tell them that the care workers work will be reduced and improved by the fact that he will be able to find out alone through technology things that he is interested in or he can administrate himself the medication using specific application for elderly. Thus care worker will have more time available to spend with the cared person and can make recreational activities with him when the time affords this. P6 - In general, care workers that are activating in the non-governmental sector are more interested in using technology and to work with beneficiaries to learn them to use ICT given the fact that their program is more flexible and allows them to do this, opposed to those who are working in the public system where the program it is very loaded as a result of lack of personnel. P3 - Social side is equally important as the basic needs. It is therefore important that carers know how to access and use new technologies to dedicate their time and work with the elderly, so as they enjoy the benefits of new technologies. There are organizations where the care worker that it is in charge with the medical side of the elderly is accompanied during the visit by the social worker and, thus being satisfied both the medical and the social aspects. Therefore, the non-governmental sector can provide home care services much better and can take from their time to help elderly to acquire basic ICT skills as internet navigation, communication on internet. P2 - Elderly people from the organization that I represent will benefit from the 126

127 advantages offered by new technologies because we have young volunteers working in home care services and they will be able to support carers and older people to use new equipment and acquire minimum skills to use ICT. Lack of time is the most important problem that leads to not using new technologies by care workers in Romania. They have many tasks in care activities and the number of hours allocated to each beneficiary is limited. Question no. 3 - What new digital skills will care workers need? What should be included in a carer s digital competence list? P8 It is very important the age that care workers have but also their interest to acquire ICT skills. Regarding technology skills, they must have basic skills to use a phone, a computer, and Internet use skills. Skills they must possess are common digital skills that care workers use in their private life and which can be transferred into their work. More than that they must have and the non-digital ability to raise the interest and to encourage others to use something new. P9 they have to know internet navigation (IE), Communication (messenger), Social networks (FaceBook). P7 I think that ability to use a text editor is very important for carers. Thus, they will be able to complete daily forms without to have to write by hand, and this will make them to gain more time. To know how to use a printer to print their forms is also important and to stock information on USB, so they can carry out information if needed. P4 - Even Excel skills are very useful for them. It will help them to organize better. If there will a person willing to be patient and to show them new things, they will be interested in learning even difficult operating programs such as Excel. P1 - In my opinion even the software called One note (with which you can take notes) could be very useful for carers. It can replace the functions of Word and Excel in terms of notes-taking. You can even record voice with it. P6 - Training courses that will include programs to support care workers to develop their ICT skills through which they can achieve database, learn to create their own online space where they have stored all the necessary documents. Some basic cloud computing elements. P10 - A minimum ICT skills standard should be developed for all care workers, and those who want to learn more, will have the opportunity to do this of course once they have basic information s. For example IC3 - this is the global standard for nurses in Germany. It contains three components: General Computer Skills; Component of online communication (living online) Basic Key applications: simple text editors, spread sheets in order to realise databases where can be made sorting and filtering operations, making presentations. Overall framework that was adopted at European level is sufficient for care work activity we don t have to forget that in the first place a care worker provides care services. They 127

128 need basic ICT skills not a very high level in IT. Free discussions on the workshop theme P1 As a conclusion, the use of technology will be very good for care workers and experts in the field, because their working tasks will decrease. If both care workers and care recipients will be able to acquire ICT skills, the experts will no longer have to complete just them all the forms regarding the care work activity developed at the care recipient s homes. The care workers can do this each day by their one. So, the experts work will be much easier and they can dedicate this administrative time to other task more important. P3 - New technologies can help care workers to communicate better with customers, so care recipients can inform them before the day of the visit which they need using a modern mean of communication as Messenger, Skype, Facebook. Currently they have a fix visit program, especially because many of the elderly can be contacted using other communication channels. CARER+: WP2 - Focus group P1: Stéphanie Vincent - Institut FEPEM P2: Jean Rémy Acar - FEPEM P3: Catherine Ollivet - France Alzheimer 93 P4: Cathy Legendre - Institut FEPEM P5: Pierre Merigaud - Autonom'lab P6: Dr. Christian Shoen - RanD P5 Autonom'lab works primarily with people's autonomy. We carry out evaluations of technological mechanisms (automation and helplines) in elderly's social environment (family members, employers) and the use of these technologies in this environment. We (CNSA) 128

129 recently carried out a nationwide survey on training in digital technologies in the construction industry plus an extension to the medical and social professions and social workers upon recommendation of Autonom'lab. We had to insist on including those professions. P6 I work for the HOPES project, which is an ambient assigned living (AAL) project financed by the European Commission. This project focuses on learning how information and communications technologies (ICT) can help the elderly at home. The project seeks to combat loneliness and isolation by improving the autonomy of these persons through sociointeraction (social interaction through recommended Web-based social networks) using a shared platform that benefits the entire elderly community across borders. This site exists in four languages: English, French, German and Italian. There is a notion of quality of information on the Web using these informal information tools; it is the notion of bottom-up based on the experiences of and feedback from the elderly. P2 The Fédération des particuliers employeurs de France (FEPEM) represents the employers of direct employment in France. Direct employment now has to deal with an ever greater range of services, and we see new skills as well as new functions and activities emerging, which are going to affect private employers including dependant persons. I have a great deal of experience with help lines and in the medical and social sectors with the development of services adapted to needs. On the basis of my experience, I have found that almost no technology has been adapted. We do work in industries where there are fascinating advances, but which are often disconnected from real needs, primarily in terms of reliability. There is rich experience in providing help lines In the United Kingdom and in Spain, where work is being done on a larger scale, which has made it possible to identify common denominators in order to generalize. We need statistics in order to market these services. In the United Kingdom, public authorities are deeply involved, and there is a certain economy of scale. P3 I participate in the work of ARS Ile de France, and I am interested in everything related to the health, medical and social fields. For the past 15 years, I have been a member of the research group on ethics, elderly society and vulnerability for Espace éthique national Alzheimer. There are obviously many issues concerning ICT for us. These technologies, which are not inferior to human but better than humans, do require us to be attentive. This is very significant for professionals in this field because this public has trouble gaining recognition in society. We must use ICT facilitators when working with the elderly. Few persons have been raised with ICT in this sector, but they, more than one would think, want to use ICT. We need facilitators who can provide positive encouragement and remain alert to ethical questions. ICT presents two major dangers for training: the danger of encroaching on intimacy and intrusion into this intimacy. How can we learn what is confidentiality and how to respect it? An elderly person who has access to a connected computer cannot necessarily begin to use it all alone right away, if that person is alone. In northern Europe, a low population density has led to the development of consultations using telemedicine. There is a need for care providers who can establish an Internet connection, prepare the visit and reassure. A danger is proselytism, in the form of orienting a care receiver to programmes of specific manufacturers. But also we must prevent other forms of political and religious proselytism. In order to prevent these dangers, the setting for training must be clear, precise and supportive. P2 We need to consolidate training that we offer concerning behaviour and environments. I am not convinced that there is a need for a facilitator for handling ICT. P3 The telephone must remain a familiar tool for communication for the elderly. It must be 129

130 possible to telephone people. Television must also remain a familiar tool for the elderly. It is clear that the digital tablet has become a playful tool, an enjoyable tool. It is not currently considered to be a tool for communications. P6 I use the term infomediary, which tends to reduce apprehension of this. When we speak of technologies, we already have the means but it is only a means, a means that must be ergonomic. ICT provides information that is not available elsewhere with the idea of regaining mobility. P3 Mobility must be promoted, but that is not the main requirement. It must be accessible and part of what is familiar. P5 The issue of the need to upgrade skills in the use of ICT is not being discussed. We have to find the right balance between ability and implementation. Should home care providers be competent in ICT? This introduces the issue of the constant evolution of ICT. All home care providers must be familiar with these technologies in order to reap the benefits for the beneficiaries, because these care providers are often the persons to whom the elderly turn for help. Care providers currently are raising questions daily concerning security and confidentiality of ICT, and their awareness is growing. In addition, they have a close relationship with their beneficiaries. For me, the issue of equipment quite often involves the categopry of the elderly. The use of ICT goes beyond the notion of support. People must be able to choose the most appropriate equipment for sending a message. The same can be said about the notion of accessibility, which is not being discussed currently. What is central is the question of assimilation. Certain surveys show that most people are not afraid of ICT, but these same persons are unaware of the benefits and the risks. For these persons, the telephone is their means of communication. P1 Training in the use of ICT for poorly trained employees in France is a paradox. In order to train care providers, we need to rely on the digital skills of professional trainers, but most trainers do not have a sufficient level of digital proficiency. The big challenge is to help these trainers in order to reach our target, which is the care providers in training. P4 At the Institut, we support training institutions with our experiments at innovating to deal with and introduce digital practices into their teaching methods. We explain to them the importance for care providers to use ICT, to improve their employability, gain recognition for their profession and their skills as well as the advantages of learning among peers. P5 We often have to deal with issues of use. What is important is to clearly identify the goals for which we train care providers. We could begin with the premise that ICT did not exist in their environment. ICT is an element in a context. Which are our goals? We must form these care givers using an initial criterion that will identify the needs that ICT can eventually fulfil. It's a way of giving them a means of existing and a value to their work. P3 The home care provider must be able to use computer applications to meet existing needs. P6 We must also start with the needs of the elderly. P5 We must also realize that needs do not always pre-exist, because in the case of ICT these 130

131 needs are still unknown. P1 We should perhaps think in terms of scenarios of use. What do you think of the current situation? Do home care providers have digital skills? What are their needs? Which use are they currently making of their skills? P2 The situation is very disparate, the average difference is enormous. Some care providers are very acknowledgeable, and others have no knowledge. P3 Their access and knowledge is also in relation to their geographic location and their level of language development. Rural environments do not always facilitate the use of ICT. Likewise, the level of language acquisition does not facilitate their use, especially among immigrants. P6 For example, the use of the telephone is growing, because its rate of penetration has boomed over the past few years. As for the Internet, its use will probably not be as important as today. Finally, the skills required for use (assimilation) of digital technology must be relatively low. P3 Use of the telephone is indeed important for communicating. On the other hand, its inherent autonomy is relatively low among the persons with little contact with this need up until now. P5 Concerning the use of ICT, the organizations that employ home care providers take into consideration their interest in training these employees for a specific purpose: how to quickly answer an alert by reducing the time it takes to provide information. For example, in the medical and social sectors, the idea of using a camera and the possibilities of observing in the event of an elderly person's fall raises several questions. We know that tomorrow we will be able to see that fall live on a smartphone. The main question that arises is which function will that serve? P2 Provision of that service must be taken into account. P3 That requires making care providers understand their interest in this type of tool, or else it will be experienced as film. There are challenges to overcome, namely reticence, skill and legal considerations in the context of France. Reticence to use ICT to intrude, lack of skills in using ICT and legal considerations surrounding intimacy and confidentiality. P5 We can organize what we want to offer as technology for home care. Training can be oriented towards technologies that ensure traceability. P3 In France, we have strict laws in the form of labour laws and limitations imposed by the CNIL on intimacy and confidentiality. We must make home care providers understand the positive uses of technology, while at the same time being indirectly aware that they can become negative uses. P6 To inform and train implies taking on more responsibilities. That is a way of giving importance to the work of a care provider. 131

132 P5 Technologies tend to change the nature of the work of care providers. What is important is to take advantage of ICT in order to improve the quality of life of the elderly. P6 Working with ICT has advantages and limitations. ICT creates the possibility of closer and closer traceability. P5 We must measure the impact of ICT against improvement in the life of the elderly directly and indirectly. Directly, at the time of the installation of digital equipment and indirectly at the time of its use with assistance of a professional. The service provided must be measured against improvement of the care receiver's quality of life. How can information be used to improve work in order to improve the relationship and improve confidence? P6 We must not dismiss concern for traceability and monitoring of work using ICT. That can block acceptance of its use by professionals. P5 Should professionals be supported by new organizations? The notion of the incorrect use of ICT implies structures for professionals in their legal obligations. P2 There is a notion of environment. Uses must be promoted among care providers in relation to the home and family. One of the main goals is to promote a social link and social inclusion. That works only if the elderly person is in the immediate environment, in a relationship of proximity and solidarity. Thus, technology can improve the surroundings, making it more human and closer, creating a link with real life through the use of technological tools. P5 Technology allows us to create conditions of proximity. Internet allows operating remotely and in the immediate proximity. Alerts raised by neighbours is one example. P6 The idea is to create tools and develop skills for backing a care provider locally for replacements and peer support. ICT permits new uses. Tools and skills must ensure the responsibility of the professionals. The Voisin-Age Web site offers the possibility of facilitating contact among neighbours in supporting an elderly person and organizing visits. These participants can use an alert network in support of an elderly person to organize a reaction such as an emergency plan to counter a heat wave. P5 As for home care providers, a source such as the postal service is seriously considering developing home visits even if there is no mail to deliver in order to create a link and break the isolation of certain persons. What is important for me is the offer of a service and not its use, which brings up the notion of support. Home care providers must propose a service that has a positive impact on the quality of the life of the elderly. P6 In my opinion, what is important is precisely the quality of life of the elderly and the quality of the relationship with care providers. Problems, uses and future services must be identified. A service must always have a sales argument in order to exist. That the notion of a service whose experience and feedback can be shared among the countries in the European Union is for my a very important factor of added value. P1 132

133 In conclusion, can you identify the important digital skills for care providers in this sector? Which skills should be taught? P2 They should not be beyond the skills that care providers use for their own needs in running their homes, managing their work and carrying out leisure activities. Teaching skills should be appropriate for implementation in a given context and at the level of understanding of the care receiver (just as our children adapt to our skills, which are more limited than theirs). P3 For me, each care provider must know how to log on the Internet, navigate on the Internet to find information, use software (answer, delete, discard spam, manage an address book, etc.) and establish a video link using Skype, for example. P6 In my opinion, there are skills connected with support such as knowing how to use a computer, a smartphone and related accessories, how to use the Internet and a Wi-Fi connexion in order to take advantage of the mobility offered by ICT, how to use software for monitoring an activity for the employer, their own activities and for the care receivers. They should also know how to use an application and send an SMS. Workers must know the benefits for their own professional interests, including knowing how to access information and how to share information related to their work in order to professionalize their activities, knowing about Intranet and Internet, knowing how to recognize high-quality sites on the Web in terms of content, knowing how to help one's clients in finding information and encouragement on line, and knowing how to keep professional activities and personal activities separate. Professionals must replace their toolbox with access to the digital world. P1 In your opinion, which are the new digital skills inherent to the specific needs of the home care profession? P2 They must master Internet connexions, a modem, Wi-Fi, landlines, be able to browse and exchange , save bookmarks and use an address book, use telephone applications and television over the Internet, file photos, make photo displays and download and send videos. P3 As a minimum, care providers should know how to access and use software, after training focused on ensuring confidentiality, respect for intimacy, non-interference in private files and the prohibition to use the care receiver's digital equipment for personal purposes. P6 In my opinion, the skills linked to support are knowing how to use a tablet and how to use the Web 2.0; in other words, having an attitude of interactive participant and knowing the standards of interoperability, including how to produce easily accessible content using different platforms. Professionals must be familiar with and use benefits such as those of the social networks and sharing within a community, their advantages in terms of professionalization within a network and continuity of service, be familiar with and use remote e-learning platforms as support for face-to-face training, and understand the interest of continuous training throughout life as a means of social and professional mobility. Care providers have the most frequent and longest contact with an elderly person and that person's family members. They must become a sort of super human, a sort of jack-of-alltrades. If they are unable to satisfy all requests and answer all questions, they must know how to advise the care receiver about good sources of information. 133

134 CARER+: WP2 - Focus group 2 P1: Stéphanie Vincent - Institut FEPEM P2: Isabelle Puech - FEPEM P3: Dr. Guy Mboko - Department of Sarthe P4: Cathy Legendre - Institut FEPEM P5: Franck Rougeau - SparkAngels P6: Dominique Guenaux - UbiQuiet P7: Mélanie Tocqueville - Institut FEPEM P2 I am the director of FEPEM's studies and monitoring department. My team and I have just recently joined this project. P7 Mélanie Tocqueville, educational engineer, head engineer for skills and training for the Institut, I am in charge of continuous learning for employees in this sector and for training for certification. P3 I am a technical advisor for solidarity activities in the Department of Sarthe. P6 I am the director-general of the company UbiQuiet, and I am one of the partners in the CARER+ project as an expert liaising with our Li1 unit, which is a reader of RFID chips allowing interaction with the elderly. This unit is simple and accessible by all. P5 I am the co-founder and president of Sparkom, which has developed the SparkAngels social learning software that allows screen sharing and spontaneous communications. Our targets are local authorities, who, thanks to our software, offer an interface for assistance and learning about ICT for the elderly through younger more experienced persons. This is a learning aid in the use of ICT. This tool for transferring skills can be used without intrusion and without remote control by a computer. This tool is part of a transactional mechanism that allows younger people without training to gain access to a productive life through a part-time activity at the time of their choosing that does not require direct contact with the clientele. P4 I am the the community manager for the Institut and former community manager of the Université des aidants. Our focus is to learn how to include certain target groups into both social and digital activities. Social inclusion is also a way to recognize and put to good use their skills. P3 What do you mean by digital skills? P1 It's up to you to define them. As background, the key digital skills as they are defined in Europe depend on their use but include knowing how to communicate, how to exchange and share and how to do research using ICT tools. Nonetheless, we are here to report on everything that you feel is important to define. P3 In my opinion, our work should focus on the needs of people and raising the skills that they need. 134

135 P4 How can I adapt and how can I break the isolation are two of the elderly's main concerns. We are attempting to improve the employability and the quality of the relationship between care providers and their beneficiaries. We wish to explore the skills that you feel are important to have in order to achieve those goals. P7 The major difficulty is that care providers are already over-extended and have a low level of training. ICT tools are not a priority for these employees. We have created central points for care providers that allow them to be in contact with other professionals in order to break out of their isolation. These central points register requests for training. We know that new needs are being raised. An important detail is that care givers are isolated and a digital tool can potentially help them. P2 We are dealing with persons with low qualifications who enter this activity after a series of odd jobs. These employees are often older. Their lack of experience and their isolation should also be taken into account. How can we raise the awareness of these persons to the digital world under those conditions? There are many questions about skills naturally required that are identified as feminine skills. Under these circumstances, what is technical produces anxiety. How can we put them at ease with ICT? How can we convince them that it is easy? Digital skills are currently regarded as unnecessary. Furthermore, this segment of the population is little valued socially, because it is not always acknowledged that they have skills. A lack of self-esteem holds back learning. P7 Care providers' skills must be given importance, and skills in using ICT must be developed. P6 Should a care provider show that they have carried out their duties well? Should they clock in? Are there legal obligations that could potentially be a field for the use of ICT? P2 Their obligations fall basically within the jurisdiction of labour law. P3 Perhaps the use of ICT should be incorporated into a relationship with the employer and with other care providers because the continuity of care concerns indirectly each care provider. P7 Certification is the basis for the partnership with an elderly person who is dependent or handicapped. A number of specialists deal with the elderly. We cannot certify without this notion of partnership and learning to keep a record. P3 Records are kept for the employer and for the care providers. Are care providers now capable of using ICT for keeping records? P6 In this context, the notions of sharing and respect for confidentiality must be taken into account. Certain information concerns family care providers and other information concerns professional care providers. In the system developed by UbiQuiet, digitalized information can be entered by voice or by RFID card without the person receiving care knowing because certain information is best left unspoken to that person. If the information is digital, it can be shared by using a card that serves as a means of recording and retrieving information. A person enters and confirms information, which is then shared either in the form of text or a 135

136 voice message. Language can be an obstacle, and using our unit to give information is one of the remedies. P2 It is true that this form of transferring information can circumvent the obstacle of written information. P6 The Li1 tool is easy to use. It is a cube on which is placed an object. To communicate with someone known to the patient, a photograph printed on a card is simply placed on the cube and contact with that person is immediately established. In this case, difficulties stemming from language as a obstacle to the use of ICT are overcome by the unit. P2 It is easy to imagine how the unit can facilitate the work of a person who does not fully understand a language, while learning as a sort of on-the-job training. P3 A family member is dealing with a very isolated person who needs interaction. In addition, these people do not always have the possibility or the time to go somewhere. On the other hand, what must be taken into account is that it is very difficult for the person receiving care to risk taking the first step, which is a difficult step to take to express to their peers a daily difficulty. P7 This tool can break down the isolation surrounding what they should do for the person receiving care. P6 I would like to go back to the term employability. The profession is governed by good practices. ICT promotes the use of health and care messages and makes it possible to personalize aid. There is a large turnover in these professions, and a period of apprenticeship is required to become acquainted with the elderly. A digital tool can be a useful and effective means for communicating information. P3 One problem is that of knowing what the care provider knows and how those activities are performed. Traceability permits protecting the beneficiary and improving care providers' skills and, as a result, the quality of the service provided. Monitoring activities week by week, for example, permit traceability. P7 A diary is an effective source of traceability. Even more so because it is a tool that supports daily activities. P3 The type of assistance is itself also a determining factor. A person does not always eat their meals because that person sometimes is not hungry and needs to speak. The psychological aspect is an important dimension. By stressing the social link, the time given to a relationship can be a form of recognition and have an impact in terms of living standards for the elderly. Even more so, when a person who eats very little can later regain a taste for things through contact and by listening to another person. P6 ICT is always a supportive help and never compensates for a lack of contact. It supplements and backs up the link, but cannot replace human relationships. 136

137 P5 In my opinion, there are four characteristics. Equipment is an important factor of use. An interface is required, and the fact of not having the equipment is an impediment. Acceptability is another factor. Anxiety-based reluctance is another obstacle. It has been our experience that assistance among peers is what is most important, because the rate of transferability is greatly improved. Finally, the notion of real time is a final factor because information must be transmitted promptly. In that case, restricted access and limited mobility can be obstacles. P3 Learning from peers is very important. I have a 75-year-old friend who has been participating through an association of elderly living in rural areas. He is helping others. I was very surprised to receive a request from him inviting me to join Facebook. What struck me is that he has so willingly accepted this training in ICT because he was helped by one of his peers, a fellow retired person. P5 The notion of sponsorship is important. Requesting assistance from an institution is in itself already complicated and in some way it is an admission of incompetence. Help from a peer or a sponsor is positive. P2 Awareness should be promoted among the elderly. P5 Quite the opposite, the care providers are the target population of users of ICT. P3 There is always the notion of quality of service for an employer. This need is very concrete, very basic. We are dealing with identifying these needs and trying to satisfy them. We can do that with current tools, including ICT. P7 As for the monitoring of partially certified care providers, we cannot use to summon someone to an exam. We are working with people who do not use . P4 is the start for beginning an exchange. Training centres in this field must recognize e- mail as the basic and indispensable starting point for an untrained audience. But in practice, they do not fulfil the role of digital mediation to promote awareness among the trained staff. P1 We are still in a period where digital activities are mysterious. The fact of not having gone beyond this point of demystification makes it impossible to have a conversation about the digital world. We must approach this though the use of digital communications. We must make gradual progress. On the other hand, as a source of training, I think that we have the duty to train those who use our training to create an address and use . P3 Balavoine sang replace a need with a desire. We need to begin with a desire sometimes in order to satisfy an unidentified need. P4 f An informal approach allows us to satisfy needs. The very notion of introducing digital technologies is very important. Often, combining a desire with a touch of fun makes it possible to take the step towards practices using ICT. P6 137

138 By starting from something familiar, for example the telephone, a use can be considered as non technical. The act of taking the telephone and speaking is not a technical act for an elderly person. If we offer them the possibility of using our tool to telephone by simply placing a card on it, that person is going to understand right away and will use this technology to communicate. Use is accepted either through a desire or through a known usage, such as communicating or reading. When a technology is well thought out, it can overcome a handicap, such as poor vision. P5 There are two ways that the use of ICT is accepted: an emotional response (the main source of acceptance for care receivers, namely the elderly) and improvement of the quality of work (the main source of acceptance for care providers). P6 I am not at all sure that is true because simplicity is also a source of acceptance for the two target populations, and promotion of the profession of home care providers seems to me to be more appropriate. P5 A social network affects the care provider's attitude and makes possible a raising of the profession's image. P4 The notion of attitude concerns these two groups: the care provider's sphere of their profession and the relational sphere that puts the human being at the centre of a relationship. P5 And this allows them to improve their employability at the same time. Trainee accompanying P3 With the use of a sound-based diary, the sound of a voice can make its use fun and create a desire. P7 In addition, the written language is a frequent stumbling block for care providers. P3 Concerning the elderly, based on our department's experience, there is very little experience with or initiation in ICT and something similar to a hot line. What ICT can best provide is a break in isolation by reinforcing and decreasing distance. If a person is dependant, this notion of communication is even more important to maintain. We know that health is a combination of factors and that its components are very numerous. Even the notion of habitat is one factor. There are also many benefits. P5 Different care providers use different tools. One of the problems is coordination of these tools. ICT, as one of the sources, can help to back up the professions and help to focus a set of services on a single person. P3 ICT can coordinate the activities of care providers at the local level. Real time allows reaction by care providers. P7 Efficient management of home care is an economic challenge. P6 138

139 Local authorities can eventually manage this bringing together of the multiplicity of care providers. P6 There are places in certain regions where the promotion of ICT can support this type of activity. P7 The demographics of the local area are also very important. P3 Isolation is not necessarily limited to rural areas. Look at the example of metropolitan areas. P1 In your opinion, what would be the digital skills required for workers in this field? P3 We have asked several companies to carry out experiments in home care. We are currently experimenting with ICT tools. Often, an elderly person looks to their care provider. P7 Television is a tool for interaction. P6 It is also a way to avoid a relationship. P7 The elderly watch television, so that is an important subject of discussion. A television that no longer works for an elderly person who is alone is a major breakdown in their daily life. P6 It must be remembered that before speaking of ICT, television, the telephone and their accessories are technical equipment. P1 Do you feel that one of the skills would be to know how to turn on or reboot an Internet connection? P6 No, that is not very complicated. On the other hand, knowing how to reach the appropriate person in the event of a breakdown is an indispensable skill. P1 Which would be the so-called basic skills? Would they be related to the tool's technical characteristics? P7 I think that digital skills must be a tool of traceability related to health, above all for their wellbeing. Trainee accompanying Dr. Mboko Perhaps a few simple skills, such as knowing how to use a computer, a tablet and to send e- mails. P5 Knowing how to use standards, recognizing symbols. Five per cent of the calls that we receive at FAI show that most people do not even know how to make an Internet connection. 139

140 Insisting on the notion of learning among peers and among care providers is also a way to make information easily assimilable. P3 There is a experiment between a retirement home and a summer camp for children, which created an intergenerational link. P7 We teach our home care providers to create a support network for their colleagues. P6 We have tested games among very young children (4 to 6 years of age) and the elderly. Contrary to expectations, that was a great success with the creation of a very strong link between generations. P7 The playful aspect, in addition to simplifying digital tools, appears to be essential, including colours and design. These are means for acceptance of these tools. P4 At the Gaîté Lyrique, there is a RDV of playful activities for the elderly. They learn to play all the games, even WII for example. They can then play among themselves or with their grandchildren. Many of them enjoy playing games. P6 When we began, we proposed games for a population suffering from Alzheimer's disease, namely simple and easy games, but we realized that for a portion of this population that was not what they wanted. Now, we offer competitive games, because some of the elderly still want a challenge. The intellectual difficulty of the games that interests them is often beyond the capacity of the facilitator. For another portion of this population, we try to recreate an emotion. Carer+ Report Phase 2: Focus group session transcript Partner organisation: Country: Reporter (+ address): ISTITUTO PER LA RICERCA SOCIALE ITALY Date of session: 20/11/2012 Place: Duration: Francesca Di Concetto fdiconcetto@irsonline.it Milan 1h Number of participants: 4 140

141 Summary of the session outcomes: The focus group involved 4 participants within the IRS Scientific team. The session opened with a short presentation of CARER+ and its objectives and an illustration of the pilot action to be developed in Round 1 : What digital skills do care workers in Italy currently need and utilise? To what extent is ICT used in the field of care work? P4: A recent research made on employment centres and VET centres involved showed that Italian women who access courses for care workers or who apply for a job as care workers are mainly low-educated and fall back on care work because they cannot find any other job opportunity. On the contrary, care workers coming from other countries generally have higher qualifications and may have done clerical jobs in their countries. Therefore they are more likely to have higher ICT competences. A research conducted on care workers a few years ago showed that 64% of respondents had prior work experience in other sectors, and about ¼ of these had been working in positions such as manager/entrepreneur, highly specialized intellectual profession, or administrative management. The research also showed that 1/3 of foreign care workers has attended training courses in Italy. 12% of these has attended an ICT course. P2: I would like to add that unfortunately care workers ICT competences are generally low and limited to computer use. Mobile telephony use is limited to cellular phones and rarely expands to tele-care and video-monitoring. Round 2: How could ICT be further used to support both care workers in their work and care receivers in their daily lives? P2: Domotics skills could be a helpful addition to care workers ICT skills, as well as skills in the use of digital technology to interact with their country of origin. I am more doubtful about older people using technologies due to cultural difficulties, age reasons, and learning limitations caused by impairments that usually affect older people needing home care. P4: I don t think there is a need for care workers to use digital technology in their jobs, and I also think that this is a very inessential matter for families needing a care worker for their relative. However in a few cases having a care worker who can use a computer might represent a benefit for an older person, above all for maintaining relationships. She could help him in using Skype to talk to children and grandchildren, she could show him photos and videos sent by relatives, or even write s for him. Like Sergio I am very doubtful about the possibility of older people to acquire digital competences for them to use these technologies themselves. P3: Surely a care worker could benefit from acquiring digital competences since we are moving towards telemedicine and let s not forget the personal use they can do of these technologies to keep connected with the world outside and with their families. This would have a strong impact on their quality of life and as a consequence also in the quality of life of the person being cared for. As regards digital competence for older people perhaps this could be applied in the future but not to older people who are currently being cared for and have cognitive or physical impairments. P1: If the care worker intends to invest on her professionalization, then using simplified technologies in cognitive rehabilitation would bring added value to the services she provides. And this skill could be transferred also to other occupational contexts in the future. From the point of view of the person being cared for, the new ICT aids are important tools to support communication and relationship with patients having cognitive deficit, but they could also 141

142 become tools for social integration. Round 3: What new digital skills will care workers need? What should be included in a carer s digital competence list? P4: With respect to computer use I think Internet, , video and photo editing/management and use of CD/DVD readers. P1: it would be important to be able to search for digital learning resources. P3: Use of telemedicine software and devices for booking appointments with doctors and for downloading reports and prescriptions. P2: I would add domotics, telecare and telemonitoring. In particular any tool for health monitoring can support the work of well-trained care workers. The problem is to define professional profiles for care workers incorporating these competences, and the relevant additional costs that would on the care recipients families. It would be necessary to find a balance point between costs for technology and families possibility to afford them. Comments, any other information: 142

143 Carer+ Report Phase 2: Focus group session transcript Partner organisation: Country: Reporter (+ address): LSA + LIKTA LATVIA Date of session: Place: Duration: Martins Etkins, martins.etkins@samariesi.lv Riga Number of participants: 10 2, 5 hours Summary of the session outcomes: M.E.: Hello! My name is Martins Etkins and I am communication specialist of the Samaritan Association of Latvia. The purpose of this discussion is to answer on this question what is happening with ICT in connection with care work in Latvia? Andris Bērziņš: I want find out an answer, if these technologies introduced in Latvia would give better quality of the care work and if they would be financially attractive, because I m no t so sure now. M.E.: At the moment, how much ICT are used in the care work? How much of ICT are used by care givers and how much by care organizers and managers? Ina Irša: With us, only nurses use ICT in their daily work. These nurses are caregivers as well. Dace Veikina: We use cell phones to connect each other. Of course, we use , computers, but it would be very useful if there would be a special program for those who work in the care giving. M.E.: What are these things you expect? How ICT can help in this situation? Dace Veikina: It would be a computer program for care workers, which includes medical aspect as well as social aspect. M.E.: What exactly should do this program? Dace Veikina: It could be patients register, which includes all information about the client when the care giving started, what have done already, who does this and that. This program could help to coordinate all these things. This program could help us to make reports at the end of the month push the button and the report is ready! It s very important because now at the end of the month I spend at least 7 days to make all the reports. Ina Irša: It is very hard to process all the statistics. Bet if all the data are entered into a computer, it is very easy to get all the information about a patient. So we could compare, which group of care givers work better, if the system works, maybe need to use some other methods. We could do very, very much with a help of ICT. Ervins Alksnis: I am here because I and Andris Bērziņš some years ago talked about that it would be so good if our patients could talk to us with a help of computer, could connect with a care giver in any time and we could now, if the care giver is at place we think he is. 143

144 These are control functions and a possibility to connect with other people without going out of the home. Any person has option to talk when it is needed, e. g, he thinks he is dying, he can call to a care giver and talk and the person understands that actually everything is ok. It is hard to tell something about expenses, because in Latvia the expenses of care is very little, but technologies are expensive. I am very interested in this development, because after some time you will see here effectiveness of use of resources as well as economy. M.E.: Tell, please, your vision about the use of ICT! What should be invented from a services quality point of view? Ervins Alksnis: There are 3 aspects: 1) the quality of the service; 2) care quality; 3) administrative expenses, that would be lessen. The other very good thing which comes when ICT will be invented, is that the person can get this care when it is needed not when it pertains. It means interactive communication to both the parties. It means that care gives comes when it is needed, not when he has to come because someone has told him to come on Mondays until three. The first level of this system is a service called security button which we use. Some very god things I have seen abroad, where people use ICT for honourable ageing, e. g., there are virtual gymnastics lesson. M.E.: First contribution of ICT could be service quality control and decreasing of administrative expenses, because is more effective when ICT is used am I right? Ervins Alksnis: Yes, I would say so. Anda Masejeva: I see ICT more in care organization, not in a care work itself. It would be very necessary to make care cards, which could be used in social care work as well as in medical care, for every client. This is the opportunity to save all the history about every client and opportunity to follow, who has done what. To control if there is a movement in the apartment of the client would be appropriate. ICT for connecting with other people is more necessary to people with movement disabilities. But I am not an expert to advise anything specific. Also I see some risks that this could cause fake calls, because some groups of care clients don t know have to use ICT. Viesturs Kleinbergs: I think ministries should think of all this. I see 2 things, why we should use ICT: 1) to improve life quality but while there is no united system in national level the results would not be obvious. It will be a very expensive to introduce ICT and very hard to help clients get used to ICT. But I think in long-term it will improve life quality, especially ability to connect other people for those who are lonely. And actually this is not anything difficult you should press one big red button or on a picture of you care giver and they are coming to help you. Also it might be a reminder to take your pill; 2) facilitate work. And I see one more thing here to improve the information movement and communication with each other. M.E.: How much of modern phone options do elderly people use and how easy it could be to them? Which of these visions does Latvian Mobile phone can provide? Ģirts Sokolovskis: At the moment, smart phone is more like a computer with ability to call and many other options. Elderly people use it only to call and sometimes send messages. We offer cell phone for elderly people and it costs Ls. Also some elderly people use Skype to connect others. Also we offer additional function called Kur? Kur? that allows relatives to see where the old man is, e. g., if you can t reach him by calling. The more 144

145 important thing is the battery life of the phone would be long so you can reach this old person. Ilonija: Many seniors look at ICT with suspicion. And one more question - who will be responsible of all these devices? Because if anything happens with them ( lost, damaged ), the care giver will be blamed. M.E.: Are care givers ready to use ICT? Do they know how to use them? Dace Veikina: We have to work with care givers very much, we have to educate them. Ilonija: 80% of care givers know what is computer, but it doesn t mean that they know how to use it. We really have to teach them. Valda Ozoliņa: Security button is out technology already 10 years and I agree that this is a long-term job to inform every care giver about that how it works and what to do. But also I can say that when this person understands how it works and how to use it, he will never refuse it, because he has felt this security. You just need patience and need to inform them. Ilonija: If we talks about care givers they use only cell phones. Ina Irša: Only care givers can teach their clients and they will have to repeat and repeat if the client forgets something. And the problem is that care giver has no such extra time, because someone must finance it Viesturs Kleinbergs: We already have similar service. The person comes to place where he can gets his free food, he register himself with a smartcard, so we can see how many people has eaten, where they have eaten and so on we can control this service. M.E.: How would you estimate care givers computer skills? Dace Veikina: They have elementary skills, but we don t ask these skills form them, when we recruit them. M. E.: If we would make a web portal about care giving at home, how do you think what must be included here? Viesturs Kleinbergs: It must be like a manual for professionals and it would be useful for relatives too, because often they do not know what to do and where to get information, they don t even know their possibilities. Andris Bērziņš: Yes, and it must be connect with European portals. M. E.: Thank you for the discussion! Comments, any other information: 145

146 Results of a focus group meeting for experts in social inclusion, digital literacy, ehealth, Ambient Assistive Living Technologies with a sound knowledge of the domiciliary care sector WP 2 A2.2.2B PHASE 2 REPORT: FOCUS GROUP SESSION TRANSCRIPT TELECENTRE-EUROPE AISBL FEBRUARY AIM OF THE FOCUS GROUP MEETING One of the goals of the CARER+ project is to develop a comprehensive competence framework for digital knowledge and skills in domiciliary care work and caretaking. Once developed and tested, the competence framework will serve as a reference structure for care workers and caregivers competence development, as well as for vocational education and training providers to effectively design and plan training programmes. The development of such competence framework represents a challenge, as there is a general lack of data on digital competences for the social care sector: Lack of occupational standards: in their large majority, national occupational standards do not integrate the knowledge and skills pertaining to this new role for the care worker. Lack of educational standards: similarly, professional implementation of digital technology in care work and caretaking seems to be an area of specialisation that the traditional educational systems not yet reflect. There is very little or no references to ICT literacy are found in most VET standards. ICT and long term care are two sectors that currently have no, or very few, mutual relations on the level of initial VET programmes and qualifications in Europe. Lack of case studies: Few case studies and collections of practices are available that refer to care workers or care givers acting as mediators and users of ICT and AAL technologies for improving the quality of life of care recipients. For this reason, the CARER+ project sets out to undertake an extensive multi-national research based on a combination of qualitative and quantitative methods. The bottom-line research question is: which digital skills and competences can enable care workers to enhance their professional profiles, and result in better services to care recipients? 146

147 To tackle the various aspects of the question, the research focuses on diverse sources of evidence: Interviews and focus groups and with experts in digital literacy, social inclusion, social care, ehealth, AAL; and questionnaires to care workers in general: certified professionals, non-certified professionals and other experienced practitioners, volunteers, as well as family members. Our purpose is to bring together experts in various fields related to the scope of the project, and encourage exchange of ideas and opinions on the use of ICT skills and competences in care work and caretaking. The knowledge thus generated will inform the process of development of the competence framework. 2. DATE AND VENUE OF THE FOCUS GROUP MEETING Date of the meeting: Tuesday, 4 th of December 2012, h Method of the focus group: on-line conference Moderator: Mr. Péter Pálvölgyi, Telecentre 3. THEMES OF THE FOCUS GROUP The questions of the focus group were grouped into three major parts: 1. Current experience with implementing digital skills and ICT in care work In general, what do you think about the relationship between digital skills/ict and care work? In your opinion, how have digital technology developments influenced the field of care work? Can you think of specific advantages and challenges that digital technology poses to the field of care work? If you were to describe today s care worker s typical day, how would the use of ICT occur in it? How relevant is digital literacy for today s care workers and caregivers? In your experience, what are the typical circumstances under which today s care workers approach digital technology? Can you tell me more about typical tasks and procedures in a care worker s day that require digital literacy? 2. Care receivers needs What, in your opinion, are the care receivers needs that could be met using digital technology? In care receivers daily lives, how could digital technology be of help? Which kinds of digital technology could be used by care receivers themselves, and which would require a care worker s assistance? How do you think care receivers will react to services involving digital technology? Can you describe your experience with care receivers acceptance of ICT-based 147

148 services and activities? What are the pros and cons here? 3. Digital skills for care workers and caregivers Presently, how are digital skills incorporated in care workers qualifications? What digital skills are taught in current VET programmes in the field of care work? Are there any non-formal possibilities for care workers to enhance their digital skills? Which digital skills and competences would you name as substantial for care workers? What should all care workers know, understand, and be able to do in the field of ICT? Which additional digital skills and competences would you regard advantageous for care workers? What else might a care worker know, understand, and is able to do in addition to substantial ICT skills? 4. PARTICIPANTS Six experts were involved into the focus group discussion. Their professional background is showed in the table below: r Name Stephanie Carretero Sven Weber Andrea Schmidt Rikke Samsung Zsuzsa Széman Rosie McLoughlin on JRC-IPTS, Spain Instituti Stiftung Digitale Chancen, Germany European Centre for Social Welfare Policy and Research, Austria Copenhagen council Hungarian Academia of Sciences, Hungary VOCAL, Scotland/UK Position research fellow group project manager researcher care worker social politician, scientist information manager Field of expertise informal care long term care seniors, yout social media ICT-based solutions for inform caregivers and privately paid carer caring at private houses social policy, research work with unpaid carers (fam members, partners friends) 148

149 5. RESULTS BY QUESTIONS 1. CURRENT EXPERIENCES WITH IMPLEMENTING DIGITAL SKILLS AND ICT IN CARE WORK MODERATOR: In general, what do you think about ICT in care work, how have digital technology developments influenced social care work? P 5: In view of the various problems arising in connection with ageing, it is now quite clear that care in the future will be inconceivable without ICT. Nevertheless, in general it is important to emphasise the heterogeneity of ICT devices. There are devices widely in use in both the old and new member countries in formal care, either incorporated or in the process of incorporation into the care system, that provide security for the recipient of care and are important for both formal and informal carers, that are fully accepted and easy to use for both the carers and the elderly, such as the emergency alarm systems. Market actors too, have taken up the production and further development of this type of devices. Very costly new devices have also appeared and are being further developed, e.g. devices monitoring the elderly. In contrast, the various ICT opportunities offered by the internet to assist care are less well known in the new member countries. P 4: Digital solutions can increase the service level given to the receivers but it cannot substitute the human contact and care. P 6: ICT provides many relevant and cost effective solutions within health and social care, supporting legislative and policy developments in areas such as personalisation and tailoring support to individual needs, self-directed support and integration of health and social care. P 5: International and national projects carried out in the recent past in this area unequivocally confirm the positive impact of digital technology on care receiver, formal and informal carer and the good examples found are speeding up further research and dissemination. For example the AL projects, HAPPY Ageing, CARICT, Skype Care Hungary, Help the helpers Hungary... care? MODERATOR: What are the main advantages and challenges of ICT use in social P 3: It is important to distinguish three different perspectives when talking about ICT skills in care work. First, the older person s view as a user, second, the care workers views in the formal sector and third, caregivers views, both informal carers and privately paid carers. For each of these stakeholders there is a 149

150 different benefit of the use of ICT. I will focus on the advantages and the use of caregivers: from an analysis of initiatives in European countries on the use of ICT it can be said that digital technology has started to influence caregivers work not to a large extent so far, but a lot of potential is seen by the people involved. For example, distantly living family caregivers may use skype to communicate with their older relatives, thus keeping them integrated in their family life despite not living in the same place. Also, for carers of dementia patients it can be very helpful to have sensoring technologies installed in the older person s house to reduce the need for constant presence in the household. Data protection issues as well as questions of adaptability of the older person s house should be always kept in mind, however. Finally, in cases of physical limitations, ICT can help to maintain older people active and self-confident longer, for example by providing them with an emergency wristband by which help can be called immediately in case of need e.g. by pushing a button. These solutions have been among the first ICT solutions in care and are established even in countries with otherwise limited use of ICT for care of older people. In all cases, however, it is of utmost importance to ensure the political commitment of public authorities to assist in the funding and development of ICT solutions. Otherwise industrial representatives may refrain from implementing innovate solutions too early, or withdraw after pilot-testing. P 5: The level of IT knowledge of care workers can be a great challenge, too. Care workers accept with confidence the widespread and known devices, urge their wider use and consider them useful. They are mistrustful of the opportunities offered by the internet or not aware of their significance because many carers do not have skills of this kind, do not know the care possibilities inherent in ICT and/or the necessary infrastructure, for example internet access is lacking. P 6: Yes, it also presents challenges for carers who are offline or do not engage with technology. This is particularly relevant as government and local authorities are increasingly using technology to communicate key messages and information. There is a social and economic divide between carers who engage with technology and those who choose not to or unable to engage and there is a need to support this gap with resources and training. MODERATOR: How relevant is digital literacy for today s care workers and caregivers? P 6: Unpaid carers are increasingly using ICT and digital technology to support their knowledge and build confidence in their caring role through information websites, e-learning and training, care management and co-ordination applications and Telecare. P 1: I don`t have experience in doing this work on the field, but studies show that carers have difficulties in using the ICT, because they do not have good digital skills. In the case of formal carer, it also exist a reluctance to use them, because ICTs involved a change in the organisation of the delivery of care. Carers need to have digital skills, the use of ICT can provide a lot of benefits doing more efficient their work, but also improving the quality of care and their quality of life. 150

151 P 5: The internet has become an integral part of the life of young people, but the level of internet skills is much lower among the middle-aged and very low in the case of the elderly. In Hungary, for example, statistical data show that only 5% of the older age group use a computer. A considerable proportion of carers are middle-aged or older. Often they do not have computer skills or even access to the internet. Two groups must be distinguished among the elderly in this respect. Increasing emphasis is being placed on acquiring digital skills among the active elderly and there are many programs assisting this. But society, family, young people mainly over 25, carers and market actors regards elderly recipients of care as being no longer capable of learning, considering them incapable of acquiring internet skills. MODERATOR: Can you tell me more about typical tasks and procedures in a care worker s day that require digital literacy? P 5: Promotion of reconciliation of care and work, social integration of carers and or care recipients, ensuring more leisure time and social participation of carers, improves the quality of life of both carers and care recipients. P 4: The use of computer technology gives an increased control as more job functions can be registered. The staff digital understanding, is essential in order to benefit the full use of IT s potential. It is important to be able to see the reasons and why s. Digital skills and implementation of technology must be developed in coherence with staff as well as receivers. P 1: Carers can use ICTs for different kind of activities mainly to help them for the independent living of the elderly, to allow them for social activities and relationship for families and friends, for acquiring information and competences, and to coordinate the different social and health care services. P 2: Recently, there have been two projects that we have been carrying out with. In one project, we equipped the seniors living facilities with tablet PC device and an internet access, giving them the opportunity to enhance their own life quality by the use of ICT. In another project, we consulted senior residencies in installing an ICT infrastructure in their facilities and implementing courses or other activities to the seniors. There is a strong connection, since care work is still not as digitally determined as it could be. Care documentation, observing blood values, and body functions can all be automated and therefore have a lot of potential in enhancing the care givers work. Taking pictures of wounds, documenting, which patient you already have been visiting and how many minutes this took. Care givers belong to the professional groups who are walking a lot in their everyday life all this information can directly be transferred to a central server and synchronized with it without having to walk from the are receivers room to the office and back again. P 6: In the UK, , Skype and other electronic forms of communication 151

152 are tools that many carers use on a daily basis to keep in touch with family and friends. Websites, such as information sites may not form part of their daily routine but may be used to deal with changes in the caring situation, book courses or to get more information about a particular condition. For carers whose homes are fitted with Telecare devices, like detectors, alarms etc. these devices form part of everyday life. P 5: ICT appears in a care worker s typical day in Hungary only in the case of home care with emergency alarm system that has been a supplementary part of home care since It is widely available throughout the country but it nevertheless missing from home care in many areas. Its further spread can be slowed down by the manner of financing, the system of applications for financing, and the demand for the service. As a consequence, this form of ICT does not appear in the carer s daily activity, but only in case of need. 2. CARE RECEIVERS NEEDS MODERATOR: What, in your opinion, are the care receivers needs that could be met using digital technology? P 1: Older people have different needs, mainly focused on carrying out activities of daily life, like basic activities of daily living, these are the ADLs, such as bathing, dressing, and getting in and out of bed and with instrumental activities of daily living (IADLs), including household chores like meal preparation and cleaning; life management such as shopping, money management, and medication and transportation. IADL are the main activities that ICT can help elderly people. I suggest to have a look at the reports of ANCIEN about the Role and potential influence of technologies of the most relevant challenges for longterm care. I can also offer the Technological solutions potentially influencing the future of long-term care by Rossi et al., from 2012.They are both available online. MODERATOR: Thank you for sharing this information about the studies. P 2: It is difficult to generalize when it comes to the care receivers needs, but a lot of them have reduced mobility. The internet can outbalance the existing mobility deficits. It can enhance the life quality of seniors with simple tools. The internet is a medium that is based on experience everyone has to try it to see the benefits of it. This is why the care givers need to have a good personal contact with the seniors to find out what they are interested in. Then it will be easier to give them tools to communicate with friends that are living in other cities, relatives that do not live nearby. P 5: ICT tools can promote daily activity, it helps them to be more active, to help to counterbalance the deterioration of physical and/or mental health, to maintain 152

153 interpersonal contacts, it provides security, improves orientation, ensures meaningful use of time... help? MODERATOR: In care receivers daily lives, how could digital technology be of P 2: They can do their whole communication with public administrations via the internet, looking up the public transport system to gain back personal freedom and again: there are always things, that have personal relevance for every single care receiver, be it regional history of just hearing the sounds of animals. Virtual city tours via Google Street View or an assisted Skype Call are not demanding a lot of IT skills, but have the potential to increase the life quality of the care receivers. Observing IT instruments can support care receivers to live independent in their own flat since e.g. if a care receiver is having a breakdown, an emergency call can be automatically sent off. P 5: This has been best explored by a new model programme in Hungary. The aim of the Skype Care project ( ) was to end the social exclusion of sick lonely elderly persons with limited mobility, living alone, suffering depression and receiving LTC from formal carers, but who were digitally illiterate, by teaching them to use the possibilities offered by Skype and the internet. The research applied an entirely new method by involving 16-year-old volunteers thoroughly familiar with modern digital technology to provide regular help for the elderly in learning. The positive result of the model programme was that the elderly acquired the same ICT knowledge and skills as the young, their loneliness ended, their network of interpersonal contacts greatly expanded, they found a new daily activity, 3-5 hours daily, and goal in life, they were re-integrated into society within a short space of time, by the 6th month. This was achieved basically with the help of the young volunteers, and after a while led to the re-integration of the elderly by themselves. The care costs were reduced and there was no need for medication against depression, for hospitalisation, etc. The care activity of the formal carers was reduced, for example there was no need for mental care. Mental care and monitoring also became easier for the family who gained more free time. MODERATOR: Which kinds of digital technology could be used by care receivers themselves, and which would require a care worker s assistance? P 3: A big factor to be considered is the type of limitation that is dealt with: the degree of physical and/or mental limitation in health of an older person determines to a large degree which kind of ICT can or should be used. It is important to involve caregivers and their families in decisions over which solution to buy and/or install. Especially in cases of having to install monitoring or sensoring systems like video cams, the adaptability of the house and the design are important. Older people may not be able or willing to change their daily habits or see their environment changed. At the same time, studies in Sweden have shown that formal care workers also need to be trained when dealing with ICT solutions, e.g. in case of tools where older people may connect directly with formal care organisations. 153

154 P 5: It depends on the ICT device concerned. Accustomed, familiar devices are sought and popular, e.g. the emergency alarm, those they are less skilled at using are not popular because they often do not meet the needs, and their use is generally too complicated. MODERATOR: Can you describe your experience with care receivers acceptance of ICT-based services and activities? What are the pros and cons here? P 4: IT solutions can enable the receivers to take more control of their own situation. IT solutions can give the receivers better understanding and more information of their own situation. Digital solutions can improve life conditions. P 1: Care receiver can be reluctant to use new technologies, because they feel unsecure. We saw in the CARICT study that for example for ACTION in Sweden targeting the use of a video system through which formal care staff can communicate with carers, it was a success for the acceptance of the ICT service to present it as an assistive device to help the elderly in their day to day life. P 2: If the care workers can create personal relevance for the care receivers and are patient in showing them the potential of IT, there will be no problem in introducing the new technology to older people, especially since new tablet devices can tear down existing coordination barriers like the usage of a mouse. P 5: Most elderly care receivers are afraid of the internet and the computer and thus of the solutions linked to them, they do not even like to turn on the PC, they think it is detrimental to the health. In extreme cases they are afraid it will infect them with a virus or that it harms the environment, e.g. the mouse will eat their food... P 3: I would like to add, that it is needed to engage with others despite having to care for someone. Given the expected increase in prevalence of dementia and other mental diseases it is of huge potential to have ICT solutions tackle also light physical needs of older people. That is, a dementia patient may need constant supervision despite being physically active and healthy. In these cases family caregivers easily become excluded from social life and/or the labour market. ICT solutions, e.g. monitoring mechanisms may help to overcome their exclusion. 3. DIGITAL SKILLS FOR CARE WORKERS AND CAREGIVERS 154

155 MODERATOR: Presently, how are digital skills incorporated in care workers qualifications? P 2: Care workers belong to a group, whose everyday work is not characterized by the usage of IT. The usage of IT will probably increase the next years since there is a lot of catch up potential in supporting the daily routines and automate process in care documentation and control. Still, the required knowledge is basic and demands offering the care givers to receive basic digital literacy skills. P 5: At present this is not yet a criterion. A big Hungarian non-profit organisation, the Hungarian Maltese Charity Service is elaborating a non-formal internet programme called Help the helpers, that provides practical help for carers in many different areas of care, transferrable immediately to countries of Central Europe with material in their own languages. P 3: There is a huge need for training. ICT offers sample possibilities for online courses, e.g. via video or interactive tools to train family caregivers and privately paid carers, e.g. migrant carers. This could ultimately improve the quality of care, the well-being of carers/their qualification, and the integration of carers. MODERATOR: What digital skills are taught in current VET programmes in the field of care work? P 3: I have no information about the current integration of digital skills in care workers training and/or curricula. P 6: For unpaid carers, there are no specific digital skills qualifications, although there is support available through voluntary organisations, local authority libraries and social enterprises. MODERATOR: Which digital skills and competences would you name as substantial for care workers? P 1: Carers need to receive training in digital skills to use ICT based services for domiciliary care. Training programmes are needed for the range of care professionals involved to support carers, but also to help them learn new working practices and the value and limitations of the new tools. The deployment of ICTs requires that those directly involved acquire a range of specialised knowledge and competences. They must also have access to IT infrastructure. This is challenging as we are working with people with low digital competences and there is a lack of technological infrastructure available and financial resources to acquire IT materials. P 2: We have to differentiate between IT skills that can be used for the care-giving work and between the IT skills that can be used in activating seniors in their leisure time. The first IT skills are simple IT skills that refer to the use of care 155

156 documentation applications. The second range of IT skills is characterized by a certain overview of which services exist in the internet. Based on this, the care givers can create course offerings or other activities for seniors in their leisure time that enhance their everyday life. For care givers that are working in that field, it is necessary to have a good overview about the services but also to have an idea of privacy, data protection and all the other things the internet has to offer. P 4: Training, training and training. Training, so that they technically can operate with the various digital systems. Learn to see the advances and possibilities in using digital solutions. Specialized platforms and systems demands specialized education and training. Training must be tailored. Employees most have understanding and experience with course and effects P 5: Computer and internet skills. P 6: Substantial digital skills for unpaid carers include the ability to set up and use and internet, including e-learning modules, video and audio. Ability to confidently set up online accounts for shared networks, e.g. care co-ordination) and to engage with Telecare and Telecare devices. Advantageous digital skills include accessing and using social networking resources. MODERATOR: What else might a care worker know, understand, and is able to do in addition to substantial ICT skills? P 5: If they have the above skills, I mean computer and internet skills, they have the knowledge needed to use a very wide spectrum of ICT devices. All carers should have such skills. P 6: For paid care workers, IRISS, the Institute for Research and Innovation in Social Services recently conducted a survey of ICT usage in health and social care. They concluded that access to social media and communication, audio and video, and support to enable collaborative and partnership working were essential skills for health and social care workers. The report found that a substantial proportion of practitioners working in social services are missing out by being denied access to these communication channels. Issues included hardware, computers not enable for sound, firewall restrictions and blocking of social networking sites. P 3: The need for a better integration of formal care sector is basic, I think. Volunteer organisations, health care sector, and family caregivers. Some German initiatives, e.g. SOPHIA have shown that ICT tools offer potential to connect the formal care sector, informal carers and volunteer organisations better. For example, there can be a video tool and a wristband by which the older person can ask for help, from local care organisations or volunteers etc. in cases of need, instead of having to contact informal caregivers. Especially the integration of volunteers is crucial in times of scarcity of staff in the long-term care sector, and these solutions should be explored further. Moderator: Thank you for coming and sharing these precious experiences 156

157 with us. 6. CONCLUDING Due to the diverse territorial and professional backgrounds of the involved experts a varied picture of ICT use in social care was outlined. New and old member states experiences were both represented on some level, as well as practitioners and scientists approaches on the issue. Participants generally agreed that long-term home care practice will be unimaginable without ICT tools in the future. However, some digital gap can be perceived between the new and old member states that seemed to run through the group discussion. Experts from the new member states could report on more existing practices and a manifold technology development, though we are aware that experts opinions cannot be deemed as representative. Experts shared the opinion that ICT tools will have a positive influence on health and social care of the older people, however a parallel development of the adequate technology, the understanding and acceptance of its importance by users, family members, carers and their organizations and decision making levels as well as the improvement of the needed skills is essential. At present, these processes seem to be at different stages. The general impacts of ICT technology on social care benefit all the concerned actors as well as the whole society by the experts. It can improve the quality of caring, it can provide a better coordination of work for carers, their everyday life can be well organized, they can save and restructure time (e.g. they do not have to walk as much). The introduction of new technologies can give more freedom and self-control for the older people, it can promote a better social integration and involvement both into the family and the community, though ICT devices will never substitute a personal, human care as one expert noted. The possible advantages cited by the participants are numerous; however actors have to face many challenges. One of the main challenges is the incidental reluctance by both the carer and the care receiver, fears of new working practices and change of the environment at organizational or at home level. Generational digital gaps should also be taken into account as experts say. A significant part of carers (45+) and older people targeted by the process both belong to that age cohorts in which the use of even basic ICT tools as well as the level of needed skills are low, as relevant researches on digital skills pointed out. In addition, older people might be perceived as incapable of acquiring the adequate skills by the family or the wider society. The needs of care recipients seemed to be difficult to generalize concerning this specific issue, i.e. the use of ICT tools in social care. All the physical, mental and social needs can be relevant and be met. While several applications have been existing already and been tested on some level, many other possible solutions have been waiting for further tests. One of the 157

158 experts referred to the responsibility of market actors here, which bring up with new and new expensive devices and induce abundance, while many of these innovations may disappear after piloting and serve only market purposes. The participants mentioned numerous samples coming from their own experiences. Some devices are effective to give a help in emergency situations as elementary physical/health needs. Others can bond older people with the family members to satisfy the mental need as not be isolated. Skype or other chat applications can promote a wider networking and communication, can help with public administration and official issues as a social need. Nevertheless, more experts opinions seemed to converge that the identification of physical (health), mental and social limitations/level of autonomy of care recipients can be used as a strand to find the adequate technical solutions. Design and adaptability of care receivers homes can be also important factors as well as the aim not to change the living circumstances so deeply. Hence, social care with ICT tools should be tailored and personalized and should be decided with the involvement of the family, as experts state. Carers and informal care givers are also challenged in the process. The participants seemed to be consistent about that formal education or VET trainings hardly include and provide ICT skill development for future carers. Some innovative local projects by NGOs were mentioned by experts here. Regarding the concrete skills, computer and internet usage, video, audio and networking knowledge was mentioned as a base. However, it seems to be more, since a new working practice should be learned. 158

159 Phase 3: Individual interviews with experts Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): 3s Unternehmensberatung Austria Date of interview: Place: Mariya Dzhengozova Vienna Duration: 00:50:00 Name of respondent: Mag. Georg Aumayr Theme 1: Current experience with implementing digital skills and ICT in care work Institution / Position: Johanniter Unfall-Hilfe (JUH) / Head of Research and Innovation Centre Field of expertise: ICT applications; communication equipment and technologies; electronic authentication; smart systems Currently, The Johanniter are not using ICT in the provision of care services to elderly due to various reasons i.e. financial resources, need of a large bandwidth for the transmission of certain data. In order to keep record of work activities and tasks and to conduct care protocols, The Johanniter are now using written documentation, which is then typewritten and digitally recorded, meaning that care workers do not practically use digital skills. The only exception is by hospitalisation of a care receiver in these cases workers from the acute home care 12 have to fill in a protocol for an e-doctor system. Although the Johanniter are not currently using ICT, the organisation has submitted several projects, which, upon approval, will start at the beginning of The projects focus on the digitalisation of written documentation (keeping record of care activities, conduction of care protocols, etc.) mainly through the introduction of tablets. Mr. Aumayr explains the advantages of using tablets compared to smart phones smart phones are too small for conducting care documentation and writing quickly with them is relatively difficult. In comparison, tablets have a larger keyboard and display, which enables fast writing and saves time i.e. care workers may attend more persons. In addition, tablets and touch screens have more intuitive surfaces and that encourages their acceptance among care workers. Digital signatures of care receivers are an important aspect of a pilot 12 When patients, particularly the elderly, leave the hospital after treatment, they can easily get into an emergency situation upon returning to their home. The acute home care service of The Johanniter responds to the medical and social needs of these persons. The service often begins by picking up the patient at the hospital, taking him to his home and providing the necessary medical care. The duration of the service is from 3 days to one week. 159

160 Theme 2: Care receivers needs Theme 3: Digital skills for care workers and caregivers project called Emergency Card ( Notfallkarte ). The signatures are saved on tablets and they should enable the authentication of care receivers data. This information (mostly emergency relevant data) should flow directly into a central database, which keeps all care documentation. If the tablet does not work or something goes wrong with it, data is already saved in the central database and can be retrieved from there. This contributes to quality assurance, identified as one of the main challenges regarding the introduction of ICT solutions in care work. According to the experience of Mr. Aumayr, care documentation should not completely depend on IT systems, but take into consideration the personal competences of care workers. The interview partner has focused on care receivers needs regarding emergencies. The Johanniter offers several digital based products for elderly (i.e. emergency watch, etc.), which activate an alarm when health parameters are getting worse. However, not every alarm means an emergency: for example, if the blood sugar of a care receiver is a little bit over the threshold and an alarm is activated, a care worker should first consider why the blood sugar is higher i.e. is it really a case of emergency. That means that care workers should be capable of reading, understanding and analysing health parameters. In this context, the main competences required for care workers do not change through the usage of IT solutions. If care workers need a special education for IT systems - that will be the wrong way... According to Mr. Aumayr, during their studies professionally qualified health and nursing staff get familiar with the so-called hospital information system ( Krankenhausinformationssysteme KIS) where they learn how to manage patients data. The introduction of tablets in the daily work of The Johanniter in Vienna will require digital skills mainly from the group of professionally qualified health and nursing staff. The involvement of home assistants is planned for a later stage. The ICT skills required for dealing with digitalised care documentation should be comparable with the ICT skills needed for dealing with a smart phone: We have a very strong focus on usability of the devices and additional skills requirements will be set to minimum: care workers have to know to write/typewrite and to push the right button they should not know how to program, how to create databases are: In the opinion of Mr. Aumayr, essential digital skills for care workers to have a European Computer Driving Licence (ECDL) to be able to deal with mobile devices (to open and close apps) Additional competence is the ability to give a feedback on what is wrong/what does not work well regarding a concrete IT solution. In order to give a competent feedback, care workers will need a certain vocabulary for describing ICT systems as well as additional analytical competence to 160

161 indicate problem. According to Mr. Aumayr, the vocabulary for describing systems requires a bit more than every-day knowledge and existing trainings do not provide for this vocabulary. The ability to give a competent feedback is missing particularly in the case of home assistants. Comments, any other information: Johanniter-Unfall-Hilfe (JUH) in Austria was founded in 1974 in Vienna, where it first conducted patient transport together with the Austrian Red Cross. JUH serves areas in Vienna, Orth an der Donau, Tyrol and Carinthia. These regions have different focuses though. While JUH in Vienna is primarily tasked with emergency medical service, The Johanniter in Tyrol are mainly employed with home nursing and patient transport. There is an acute nursing service A.I.D that is specific to Vienna. Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): 3s Austria Date of interview: Place: Duration: Name of respondent: Francesco Barbabella, PhD Theme 1: Current experience with implementing digital skills and ICT in care work Sabine Schwenk, MAS, schwenk@3s.co.at Vienna 80 minutes Institution / Position: INRCA - National Institute of Health and Science on Aging Research Department Centre for Socio- Economic Research on Aging Field of expertise: Did the CARICT - study about ICT and Carework with 52 best practice examples from all over Europe -there are several issues concerning digital skills and care givers: usually theses people are over 50 years old and don t have many ICT-tools, yet. But things are changing faster than we thought. One has to differentiate several groups of users. Some users reject everything, they feel unprepared and are not interested in IT technology. They see no point to substitute the face-to-face communication for example with a physician with IT-ways. Another group is more positive towards IT technology, there is a relation with the economical status. Cities usually have a higher economical status and people are more open towards ICT than in rural areas. One always has to differentiate which kind of user one is talking about. But things are changing.. Some people can have a mobile phone and don t know how to use a computer or only use it for s and for nothing else. We are talking of quite different users with very different usage of technology. It also depends on the kind of technology we are talking about. There are some devices that 161

162 are pretty easy, they even work automatically (monitors, GPS-systems, health-status devices)and are completely out of the power of the users, there is no IT competence in this. The acceptance of the user is very important. -Digital technology developments have influenced the field of care work in several areas: For example in the Health care area, like in tele-medicinesystems=medical consultations. Meidcal and health professionals can access and monitor health conditions any time, usually by unsing telemonitoring systems. The patient has a computer with a device and a blood pressure bracelet. The user puts it on, the computer measures the blood pressure and sends the data to the care center or you have sensors to put on the chest for the heart. A computer sends the data to the care center. There is also digital communication between care centers and users who can have a consultation. -In our CARICT study we checked over 50 initiatives in 12 European countries in 5 main regions: Mediterannian Area (Spain, Italy), Continental Area (Austria and Germany), Anglosaxon Area (UK and Ireland), Scandinavian Area (Finland and Sweden) and Eastern Europe (Hungary, Chech Republic, Slovenia). We found a lot of differences in these Areas: Care Health is more used in the UK, it is promoted by local health systems, there is a big programme in Scotland. It is a growing phenomenon in the UK and Sweden, we found platforms and online communities for self-help groups, care centers for sports or emotional support. In Austria we only found online platforms. We found out that there are patterns of public spending for these initiatives: the Scandinavian market is quite developed, many companies are producing and making agreements with municipalities and local systems to sell their IT-services either B2B or the companies sell to municipalities or directly to the users. In the Mediterranean area we are not prepared to integrate our homecare with IT technology, yet. This will take about 15 years until it will be widespread because there is a big issue with acceptance. In Germany and France there are a lot of non-profit organisations offering solutions on IT and homecare, there is some public involvement but we did not find many business models. In Eastern Europe there is a market for alarm systems and monitoring is growing because they are the easiest and cheapest technologies. 162

163 Theme 2: Care receivers needs Advantages and challenges of digital technologies Advantages -Technologies can be applied to everything (alarms, telemonitoring) but there are also e-learning services for care workers and care givers: in Germany and Italy and I guess in Austria, too, there are many private people working in the care sector. There are over 1 million migrants that are employed or work illegally as 24h care givers in Italy and live with old people. In Italy they are mostly from the Ukraine, Rumania or North Africa. It is a huge phenomenon. In this case ICT would be a possibility to offer them e- learning courses(in their own languages) about how to accomplish their care giving task. This would be very useful -Social networks: another important subject are virtual self-help groups where old people can talk about depression, be involved in a social group on online platforms or take part in video group session therapies (there is a good example in Sweden called ACTION that deals with this. Older people and relatives use a computer with a webcamera, they are all video-connected with each other and a health therapist who conducts sessions. This works very well. -Homecare: new applications for the computer could be developed like mental exercises for old people or games or cognitive exercises for dementia people. The more dementia people play, the better they can delay dementia. This is quite useful. Some companies provide a console with the TV for games, a connection with the care center etc. Challenges -an important challenge right now is: even if we can provide the technological connection or platform, in many cases there is a problem of content and user involvement. I mean that there are a lot of things already(aal, social platforms, call centers) but the point is that we are more and more heading towards a social approach.users get involved in new networks so they are socially not excluded. On the one hand old people should be able to participate in networks but on the other hand there is this problem with the attitude: why should I get in touch with people I don t know?. One has to find a good motivation for old people to participate in networks. One has to make clear to them that it might be useful to them that they get a benefit from it. But there are also logistic problems. It is not very useful to get old people into a network in which people from different cities are involved. It is more useful to focalize on one area where you offer social services users from different areas won t work, this will fail. The local context is most important when starting a network. People should be physically near to each other, a first step should be to make ICT a facilitator for social action, for physical interaction. Make people aware of an on-thespot team near their homes that they did not know. Technology serves as a physical real world in this way. If it is raining outside you can contact your friends but the connection to the real world is important. So the challenge of an IT project is that it should be integrated in a local service. 163

164 Theme 3: Digital skills for care workers and caregivers -ethical discussion: there is a big discussion about ethical problems and the issues connected with it: in the public administration you have to follow ethical processes. Things have to be approved by an ethical board before you can do things. Then you have to collect a protocol of action and provide it to each user for consent. Do you want this to happen or not? There is also a problem whether old people are aware of ethical and personal implications when they sign a form. Sometime they don t care so much about this matter at first or they don t read the papers well. Sometime they don t understand and accept everything. Afterwards they find out that they don t want what they signed before. This is a problem. So one has to increase the awareness of private users and on the other hand convince them that privacy restrictions are considered and fulfilled. Researches and practitioners should balance this issue: the awareness of the users and possible benefits from the technology.even if you know an effective technology, you cannot push it too hard and too much if the users say no. Substantial digital skills and competencies -One has to separate informal from formal care givers: Informal people are usually relatives and friends who look after somebody, most of the time spouses and children. Spouses usually have low digital skills and should be introduced in using the devices. Children are much more familiar with ICT, they are younger, they use it at work or school, they know more about it and it is much easier for them. Formal sector: it would be good to integrate some sort of modules on technology in the university studies and programmes. Modules about technology that could be applied to home care. People should be trained on that. One could develop highly qualified professionals who know different instruments. Professional care givers are familiar with technologies but the issues is, which technology are you talking about? Instruments that are userfriendly ore smart phones and the robotic sector? -appropriate digital skills in formal care work are probably s and web search. s for getting in contact with the local care system and public administration. On the one hand care workers need to know how to use the Internet but on the other they need content: What should I do with a person with dementia? People are searching for this kind of information. What kind of benefits are there for care workers and old people? To which local resources and facilities do they have access to? Is there a daycare center in the neighbourhood where children can bring their parents to?one should train people to use the computer as an instrument in order to get the information they need, this would be optimal. Caregivers should feel more independent, they should be more aware of the caregiving tasks. The big topic is interaction with each other (between the caregivers), that is what they need, after all. Comments, any other information: 164

165 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): 3s Unternehmensberatung Austria Date of interview: Place: Mariya Dzhengozova Vienna Duration: 00:50:00 Name of respondent: Alexander Eder Theme 1: Current experience with implementing digital skills and ICT in care work Institution / Position: The Vienna Social Fund (FSW)/ Management assistant; professionally qualified nursing staff Field of expertise: represents FSW in several AAL working groups 13 The Vienna Social Fund (Fond Soziales Wien FSW) is responsible for subsidising and providing care services to older persons with nursing care needs within the City of Vienna 14. FSW uses digital based technologies within the framework of the PIK project Patient-oriented Integrated Health Service (patientenorientierte integrierte Krankenbetreuung). The project has started as a pilot project in 2002 and is still running. It focuses on the development of standardised electronic data transfer between The Vienna Hospital Association (including all hospitals of the city of Vienna, which are currently twelve) and the mobile care service providers 15. Data (the so-called situation reports ) refers here to the health conditions of patients who leave a hospital and need a subsequent home care. The role of FSW is to act as a central data hub i.e. FSW forwards the situation reports (received by the hospitals to the mobile care providers) coordinates and organises the provision of home care. The FSW employees responsible for the electronic data transfer are mostly professionally qualified health and nursing staff. Additionally, they visit patients and decide on, coordinate and organise the provision of home care measures. Home and nursing assistants are involved in the direct provision of home care. According to Mr. Eder, challenges by the introduction of the PIK system has 13 The platform AAL Austria provides information (in German) of different AAL working groups, In addition, FSW subsidises and organises services for persons with disabilities, persons without accommodation or housing. It offers also subsistence provisions to refugees. 15 Main objectives of the project refer to a) assessment of patients needs and to b) development of an information system of mobile care for the patients. The Viennese Health Insurance Agency (Wiener Gebietskrankenkassen) and the local government of Vienna have funded the pilot project. 165

166 Theme 2: Care receivers needs been experienced in relation to quality of received data i.e. there were cases, where information in the situation reports was not correct. Another challenge is that only a few mobile care services are currently using digital devices for retrieving electronic data during outdoor service. That means that for example, by a house visit, care workers (professionally qualified health and nursing staff) do not have a direct access to the situation reports i.e. they have to first print them out and then make the visit. Many mobile care services have introduced smart phones, but these are used for keeping record of care activities and not for retrieving situation reports. In addition, dealing with situation reports requires a certificate for professionally qualified health and nursing staff. Apart from coordinating and organising home care service for older people, FSW also funds the service, including the purchase of IT based devices, which facilitate care receivers daily life. Priority is given to security measures including the elderly alarm with an emergency call button, widely used in Vienna, fall detection devices, etc. Since financial and time resources are limited, communication activities (for example, supporting care receivers in Skype communication with family members) are not a funding priority, particularly taking into consideration that the majority of FSW s clients are above 85 years old. Mr. Eder highlights another issue i.e. the market for IT based devices facilitating the daily life of older people is growing and oft it is not clear what products are available and where to get them from. Different mobile care services may recommend different devices for the same care receivers needs. According to Mr. Eder, the main problem is that there is a lack of a central contact point ( one-stop-shop ), which can advise on the best technical solution i.e. what device should a care worker use in a particular case: It is not a responsibility of care workers to have an overview on potential technical solutions and know about their respective providers. The idea about the establishment of one-stop-shop in Vienna has been discussed in AAL working groups; however, by now there is no concrete concept. Mr. Eder mentions that the Federation of Austrian Industries (Industrielle Vereinigung) together with Philips Austria have identified the need for a central contact point 16 and are considering activities in this direction. 16 Many singular AAL solutions are already in use and one of the biggest challenges in the field of AAL is to establish comprehensive technological and organisational links between the different AAL solutions from a variety of areas (health, safety social communication) and different providers. In: Positions of the Federation of Austrian Industries, September 2012, p. 2, available in German:

167 Theme 3: Digital skills for care workers and caregivers In the opinion of Mr. Eder, using the PIK system - Patent-oriented Integrated Health Service requires minimal IT user knowledge (i.e. how to retrieve and read data) and a certificate of a professionally qualified health and nursing staff. The certificate guarantees that an employee is able to organise and coordinate the provision of home care measures for a patent. Mr. Eder explains that FSW invests a lot of time in the provision of IT trainings to professionally qualified health and nursing staff responsible for mobile care (approximately 160 persons). Some of the trainings focus on the usage of simple MS office applications other on the introduction of new document management systems. According to Mr. Eder, essential digital skills that care workers must have include basic skills in Microsoft Windows programme at user knowledge (i.e. how to edit documents, how to write a letter, knowledge about different button combinations, for example, copy-and-paste, etc.). These skills should contribute to digitalisation of the process of planning of care activities. Therefore, in-depth IT knowledge such as system control is not necessary. Mr Eder points out that although professionally qualified health and nursing staff learn how to keep care documentation, educational courses and programmes should put more emphasis on the practical aspect of how to use electronic care documentation. Comments, any other information: The Vienna Social Fund subsidises, organises and coordinates different mobile care services to older people. The following section focuses the services with highest number of care receivers between 2005 and Home assistance includes body care, preparation of meals and doing small purchases. The occupational group responsible for these tasks are trained home assistants. The number of care receivers has been growing continuously - from persons in 2005 to persons in Home care includes wound treatment, movement and mobilisation, body care, injections, administration of medication and tube feeding. Professionally qualified health and nursing staff as well as nursing assistants perform these tasks. The number of care receivers has been growing continuously from persons in 2005 to persons in Visit service trained staff of recognised mobile care services visit older people who due to physical or mental impairment have difficulties in leaving their home alone. The visit service accompanies the older people in going to a doctor, pharmacy, bank, hairdresser, etc. Important aspect is the promotion of social contacts, for example meeting friends and acquaintances. The number of care receivers of visit services has been growing continuously from persons in 2005 to persons in hour care includes individual care, support at home and in some cases, the 167

168 provision of care activities as directed by a doctor or professionally qualified health and/or nursing staff. The number of care receivers of visit services has been growing continuously from 650 persons in 2005 to persons in Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): 3s Austria Date of interview: Place: Duration: Name of respondent: Monika Gugerell Sabine Schwenk, MAS, schwenk@3s.co.at Vienna 53 minutes Institution / Position: Hilfswerk Österreich (Care Institution), Vienna Field of expertise: Head of the Department for Health, Familiy & Social Affairs Theme 1: Current experience with implementing digital skills and ICT in care work The relation between ICT and care work depends on the setting where you work, on your scope of duties. ICT usage in an intensive care department is strong and clear. Care giving relatives usually have no idea about the question how ICT usage can help them with looking after their loved ones. They don t know how to help themselves. Professional care givers know basics which depends on their range of duties. Care workers in management positions or concerned with strategy measures sometimes have very good approaches. They know about the possibilities. A big problem is how the benefit of ICT is communicated to the old people. How can you tell or teach them that ICT can be a relief for them? The professional nurses and care workers know that there are some things that can be used. People who are with the old people know that things exist but they don t have a clear picture,yet, how they can integrate this into their every day routine. The managers in the mobile care sector have an idea how one could implement ICT, they know what is on the market, some know more some know less.but what is missing are the resources and the parameters how to integrate ICT in their daily routine. What are the necessary framework conditions for making ICT useful to the people? Society and care receivers still think of ICT use as a personal service. People don t know technologies, yet, that can support them. There is a huge gap between care receivers and their relatives and the stuff that is being developed right now or has been developed already. There is no theory or practice transfer, yet. This takes time. The old people sometimes fear that technology could replace personal relationship. Who will come to see me if technology takes over everything? Who will listen to my problems, to whom can I talk to? There is fear that personal contacts will be minimized. Imagine a hospital where everybody is 17 Annual report of The Vienna Social Fund 2010, pp. 38, 42, 44, 46 and 53,

169 looked after by robots? People imagine nobody will wash them any more but they will be put into a box where a machine does it. Developments in the field of ICT and care work -at the moment this is still on an imaginary level apart from some exceptions. When it comes to technology, the current generation only knows about TVs and mobile phones.in everyday care work ICT is used for documentation registering service performance for working hours. This is common and emergency-telephones are accepted if people understand that they can do something in an emergency situation. Sometimes photographic documentation is being used for documenting wounds, photographs are sent by cell phones. E-health is not happening, yet when it comes to measuring blood sugar or blood pressure. Theme 2: Care receivers needs Typical situations where caregivers are confronted with digital technologies -When it comes to measure blood sugar, caregivers only have an advisory function, we are not allowed to undertake medical actions. Caregivers can advise patients how to use e-health instruments. It would be much better if old people were properly informed about technical devices. Information and advice would be very important and you need a caregivers competence for that. A technician could also do that, of course, but he/she doesn t know the background, the circumstances in which a device has to be used. - I think things like blood preasure measurement or decubitus (sore) prevention will be dealt with by IT. Or measuring the activity degree of a person, has somebody moved at all during the day? Also nutrition aspects will be dealt with, did somebody eat or drink enough? Another area will be memory training on the Internet, everything dealing with memory and motility. How much did somebody move? Did he/she go for a walk or not? This needs the right kind of ethical approach, of course. There are intimate areas, we don t want comprehensive monitoring. Another important thing is that every person needs a kind of personal assessment. What does he or she really need? What makes sense for him or her? You don t need the full programme of possibilities otherwise it s too expensive. Advantages and challenges in using IT-competencies for care work Advantages -information technologies would be a clear advantage if all involved people could take a look at a care documentation and discuss a patient s condition. Everybody would see the same or there could be a flow of information between the hospital and the mobile care service for integrated care. The discharge letter from the hospital could go directly to the General Practitioner. This would be the ideal instrument because at the moment there is a problem with the medication management. The hospital writes a 169

170 prescription, the GP has to rewrite the prescription, somebody has to get if from the pharmacy. If care workers administer medication they need a written medical ordinance. The whole process could be solved by using IT. The same applies to approvals of plasters or incontinence aid by senior medical authorities of health insurances. Everything could be done by electronic means. Or think about the delivery of nursing products. In the mobile care sector the GP prescribes a drug, then the neurologist, the internist and other specialists. Everyone prescribes drugs and doesn t know what the others prescribed. - Everything that would minimize the risks at home would be well accepted by people ( did I lock the door, gas, heater?), people are unsure about these things. If you would inform people about AAL with a good PR strategy, spread among the media, this would work. This has to be done on a public level like in the days when there was the fear of aids. We are talking about old people and good models for support are already available in order to reduce risks. - How can you supply information for the stakeholders of old peoples care faster and more efficiently? Both could be done by using IT. A son could take a look whether his mum has paid all her bills because she is 85 years old and might forget a bill once in a while. There could be a kind of alarm system when a very old person makes a bank transfer about more than Euro, a kind of no-go concerning unclear transactions. I am not talking about incapicitation but IT could help with everyday procedures: bank transactions, shopping, using a telephone. How do old people get what they need? _ communication technologies are very important. One has to be very aware of the danger that IT mustn t replace personal communication. It is important that people make a better use of skype and the internet for sending s but this must never ever replace personal conversation in the sense of social participation. Challenges -Ethics: IT does not replace relationships but is supportive, one segment of a total supply concept. - Devices have to be developed that can be accepted by older people. Have you ever tried to use a mobile phone with arthritis in your fingers? But the phone should not look like a device for handicapped people, it should function well but look good at the same time, that s the trick. I don t want a tool for the handicapped, I have a dream that a granddaughter tells her Grandma that her computer looks cool, that she wants it, too. If people look old their technical devices don t have to look old fashioned or strange. -IT will have to be used for people with dementia: dementia patients have cognitive restrictions but they can still use pictograms/icons for a long time. Not much has been done in this direction, yet. Dementia will double in the future and we will need s.th. that we can use apart from reading. If you go to Moscow you can also just read the icon for toilet and not the word. 170

171 Dementia patients can live a long time with using signs because an arrow is still an arrow. We need clear devices, also when is comes to operating instructions. I hate operating instructions with 77 pages, you have to find the most important stuff on the very first pages.,. Theme 3: Digital skills for care workers and caregivers At the moment ICT skills are only asked from the care management. Managers have to deal with this subject but a private care worker will only have to learn how to use a mobile phone for a performance record. They will be taught by the individual care institution. Right now a care worker does not have to possess any kind of IT compentence but a care worker can use a cell phone. He/she can track his/her performance with it. This is the only thing he/she has to learn right now. Some care workers work with notebooks or laptops. Digital skills are a specific subject only in higher degree care worker programmes but not for care workers who work in peoples homes. I don t know any informal programmes for care workers concerning IT skills. When it comes to IT skills for care workers I would wish them to be open minded for IT and don t feel threatened by it. They should feel normal about it, see it as a new requirement that one can learn. Care workers should know as much as they need and they should know how to deal with their necessary devices. With ICT technologies people usually only tell you what devices can do but they don t speak about their benefit. I am not interested in the motor of my car, I want to know what I can do with it, what is my benefit? Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): 3s Unternehmensberatung Austria Date of interview: Place: Mariya Dzhengozova (dzhengzova@3s.co.at) Vienna Duration: 01:10:00 171

172 Name of respondent: Mrs. Marianne Hengstberger Theme 1: Current experience with implementing digital skills and ICT in care work Institution / Position: Vienna Social Services (Wiener Sozialdienste/WISO) Managing director of elderly and general care services Field of expertise: Elderly and general care services The department of Elderly and General Care Services has introduced digital technologies since several years now. They are essential for organisation and planning of care activities (as they save time and improve accessibility of care workers); however, their application in direct interaction with care receivers is rather limited. The use of digital skills among care workers differs according to their competences, tasks and functions. In their daily work professionally qualified health and nursing staff use laptops with advanced functions for documentation, management and transmission of client's data as well as for communication. Nursing and home assistants use MDAs (handy with extended functions) for communication and administrative procedures such as keeping a record of working hours, signing, service delivery; MDAs contain also contact details and other important information about the clients. "The MDAs have replaced paper (documentation)". The use of digital technologies for documentation, planning of care activities, service delivery and communication (phone calling) leads to optimisation of time resources - "less time for typical situations and more time for particular ones". This permits to attend more care receivers and/or to take more time for special cases. Furthermore, care workers and care receivers could access information more easily and barrier-free for example, in the case of nursing and home assistants, who do not speak German or of care receivers with some kind of physical disability. The use of digital technologies has improved also the accessibility (per phone) of care workers, which is of particular importance in emergencies. Theme 2: Care receivers' needs The introduction of digital technologies was challenging in the beginning as some of the care workers received it with fear and mistrust, however WISO organised regularly trainings, which gave good results in the end. Furthermore, the interest of care workers in digital technologies, independent from their qualification level and occupational position, is generally very high, which encourages their implementation: Modern working is really cool. Given the fact that the professional group of care workers is very narrow, digital skills are already a competitive capital. Care receivers' needs are individual and care services are tailored accordingly in a case-by-case approach. In a direct interaction with a care receiver, digital devices are used for the daily check-up of patient s blood sugar or pressure and for the transmission of this information to a relevant health or nursing professional. The interview partner points out to the need of a permanently available and competent contact person who in emergencies 172

173 could easily connect with a professional responsible for decision-making. Digital technologies have the potential to enable this requirement for permanent accessibility and networking. Signing a document in the case of care receivers who cannot sign on paper is another typical situation facilitated by the use of digital devices. Central for the acceptance of digital devices here was the involvement of care receivers as well as the trust they have in care workers. Behind the MDAs and the electronic systems there is a network of persons and relations of trust ensure the functioning of the whole The interview partner stresses on the importance of targeted projects, which promote the introduction and the acceptance of digital technologies among care receivers i.e. this could not be a responsibility of care service providers. For the interview partner it is also important the ethical dimension in the implementation of AAL, she mentions the issue of intimacy, selfdetermination and respect of care receivers will. The resolution of the ethical dimension depends on the individual living conditions of the care receiver who should feel comfortable and secure with the introduction of AAL solutions. Essential here is also the role of the care worker as a trusted person. According to the interview partner, it could be done a lot against loneliness digital devices can bring family members at home. In this context, digital technologies could contribute not only to keeping care receivers well fed and cared, but also to the feeling of not being alone. Concrete examples however were not provided. Another important topic for the interview partner is the so-called mobile occupational therapy (ergonomics). People, who are ill, handicapped or in need of care receive a therapeutic option for making their daily life easier by making simple adaptations of their living space. Theme 3: Digital skills for care workers and caregivers Essential digital skills for care workers are: to have basic understanding in digital technologies (use of PC and handy), to have knowledge about reliable digital devices, to deal properly with them, especially in cases of emergencies, to be accurate in entering data into the system so that it can perform well to take care of the devices (keep MDAs from warmth and cold, put the PC in a protection bag, etc.) In the context of AAL digital skills are related to general knowledge about how to use the devices, how do they operate; it is more or less to have healthy common sense, it is not that complicated. Care workers are supported by the IT division of the Social Services whenever questions arise. 173

174 An obligation of care workers is to report when they note that there is something wrong with the system. For the interview partner important is the acceptance and trust in digital technologies, their introduction should not be seen as a form of control. Nursing and home assistants should trust in their abilities: I can learn, I want to learn and I will learn (dealing with digital devices). Professionally qualified health and nursing staff should not have fear from writing: I write and record and do not have fear to make writing mistakes. Yet another competence is readiness for learning something new as well as to know how to approach and communicate with care receivers (supporting them in the use of Skype, for example). In vacancies for care workers there is no a special requirement concerning digital skills. Professionally qualified health and nursing staff have developed digital skills already in the course of their education (use of PC, documentation). Furthermore, entry tests for vocational education are now computer-based. Since nursing and home assistants work directly with care receivers, they do not use PC and need actually to know how to deal with MDAs. At job entry, they receive corresponding training. In the view of the interview partner digital technology must be adapted to needs of people and not vice versa, their advantage is time-saving and simple use. The interaction between technicians and care workers needs improvement i.e. professionally qualified health and nursing staff should be more involved in the development of It solutions that could be useful in care work. Comments, any other information: Vienna Social Services has been providing social services for people in Vienna for more than 65 years. The department of Elderly and General Care Services is responsible for the provision of mobile/home care including also support and consulting ("Pflege und Betreuung"). Currently, the department has 4000 clients, employs about 900 care workers (i.e. professionally qualified health and nursing staff, nursing and home assistants, visiting service, etc.) and provides approximately 2570 interventions per day. In 2011 the Elderly and General Care Services introduced a new administrative, planning and payroll programme, which lead to the synchronisation of more than 500,000 records to the mobile devices of care workers. The IT departments of Vienna Social Services and the Elderly and General Care merged together. For 2012 the Elderly and General Care Services plan to introduce an electron system for care receivers documentation. 174

175 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): 3s Unternehmensberatung Austria Date of interview: Place: Mariya Dzhengozova Vienna Duration: 01:05:00 Name of respondent: Prof. Dr. Franz Kolland Institution / Position: Institute of Sociology, University of Vienna Austrian Interdisciplinary Platform on Aging (OEPIA) Field of expertise: Social gerontology Use of new technologies Theme 1: Current experience with implementing digital skills and ICT in care work Digital skills and IT are extensively implemented in the day-to-day organisation and planning of care activities as well as in the communication between professionally qualified health- and nursing staff and home assistants. All care workers have nowadays smart-phones. In care work itself, digital skills and IT are used in emergency call systems (for example in relation to care beds), in providing data on patient s healthcare status (blood pressure measurement). Other forms of usage, for example, a patient provides data on his/her health status via notebook or ipad and this data is then checked by a doctor or a nursing staff that is not common in Austria, it may exist but in individual projects. Theme 2: Care receivers needs The digitalisation of the organisation of care activities points out to some challenges i.e. it s difficult to provide evidences in cases when care workers are working extra hours. Another challenge is the use of digital skills and IT for documentation purposes. That is particularly relevant for nursing and home assistants who have in most cases only compulsory school certificate. Additionally, 1/3 of this occupational group are immigrants and do not understand the language. Not IT skills alone, but rather educational requirements in general are challenging. Digital skills and IT are used for the optimisation of the work of care workers and not for improving the quality of life of older people. Professionally qualified health and nursing staff as well as nursing and home assistants have to provide the vital care service, which is tailored according to the individual needs of the patient. And the time for that is limited. Therefore, simple communication activities in the leisure time (i.e. skyping with friends or family members) are beyond the tasks of these occupational groups. That could be a task for the visiting service. However the educational level of this group is rather low and most of the employees need training in basic IT skills. On the other hand, the wages for the visiting 175

176 service are so low that it does not make sense to invest in training. There are good ideas about the implementation of AAL; however it is difficult to apply them in the practice. If you look in the household of a 90- year old care receiver, you will find very little IT-technologies. For example, there is no a digital solution of switching-off the stove and it is also not needed. The person doesn t cook him/herself anyway. It doesn t make sense to have digital solutions for these things. Theme 3: Digital skills for care workers and caregivers Digital skills are a qualification requirement for professionally qualified health- and nursing staff, but not for nursing and home assistants or employees of the visiting service. Digital skills (for example, in documentation) are integrated in the curriculum of professionally qualified health- and nursing staff. Nursing and home assistants do not need actually digital skills and these are not part of their training. Key training elements are how to lift or to feed a patient, how to provide general care. Basic digital skill for care workers is to know how to communicate via smart-phones as well as to handle with emergency call systems. Dealing properly with a smart phone needs basic computer literacy and that could be complex what will happen if the application or the system breaks down and the person needs immediate help there is no stability in the use of all these tools. Through the process of digitalisation of the society everybody will have this basic computer literacy rather than to achieve it through trainings. There is no need to teach a nursing assistant how to communicate through . Comments, any other information: According to the interview partner, in Austria there is a need to better promote good practices: where in the daily work of care workers there are IT solutions that work well and why do they work well? Another important topic for the interview partner was the privacy issue in the context of ALL solutions...how could the patient protect his/her privacy? That is a challenge. Is there a possibility for ALL systems to monitor only some spaces while other spaces remain private?... Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ 3s Austria Sabine Schwenk, MAS, schwenk@3s.co.at 176

177 address): Date of interview: Place: Duration: Name of respondent: Susanne Schinkinger Theme 1: Current experience with implementing digital skills and ICT in care work Vienna 50 minutes Institution / Position: ZIT-Technology Agency of the City of Vienna, (supports/subsidizes companies with innovative inventions) Responsible for the Health and Care sector Field of expertise: speaker in AAL Forum 2013/ Expertise in medical informatics and Health Care Science, You cannot generalize, the use of IT in care work depends on the individual person and how he or she deals with the computer privately. Patients mostly have hardly any IT skills, they are forced by relatives to their luck. Also the basic care worker doesn t know much about computers, yet. Just if care institutions demand it, people have to use an i- pad for data documentation. _ electronic recording is happening on a general level, everything else is just starting. There are studies about how to use devices and how patients react to that. - the most progressive devices in care work is the use of i-pads at the moment.. some of the old people don t like them at all, others do. my grandmother (75) manages her i-pad and reads the news on the Internet because she doesn t see well. She was forced to her luck. We gave her an old computer for playing cards on it, then she got the Internet connection. Now she is already on facebook, writes a lot of s. She can enlarge everything which is a big advantage because she couldn t read books any more. Many people with eye problems use i-pads now. At the moment IT-competencies are not very important, yet but we will definitely need them for our patients and in our care worker programmes in the future. We will need care workers who know the basics about computers. We will tell them what s on the market, which products can be used for home care and the patients. If the authorities are against this then it won t work. But the competencies will become necessary,. But if patients or staff are overwhelmed they won t use it. They have to feel well about it. Advantages and challenges of IT competencies in care work: Challenges: - old people and care workers will have to know and understand ICT. If I know what it is all about then I will use it. The challenge is that especially patients who need home care belong to a generation who has never used ICT. This will be different for the next generation. Now you have the challenge to give an understanding to the people about these gadgets. You have to help them overcoming their fear. --at the moment the biggest problem is that everything has been developed but there are no business models who is going to pay for it. This 177

178 is the main reason why many things are not used, yet. Advantages: there are advantages but many patients don t see that, yet. Some of them only use the emergency-bracelets to please their relatives. - it is an advantage being able to speak with my relatives using a videophone when I am not mobile and locked-in in my apartment. Or if I can make some kind of physical training or rehab over the video-phone. A therapist shows the exercises, this would be great for people who cannot leave their homes any more. -these things have to be communicate much better to the public on a big scale, e.g. the media write many bad things about ELGA (electronic health file). One should explain this system more elaborately, fairly and squarely, nothing is 100 per cent safe. -social communication with the outside world is an advantage _Institutions can capture and get hold of data much faster Everyday confrontation with digital technologies: -a few institutions already use i-pads, this will increase -many old people already use cell phones or smart phones or pensioners cell phones. You have to keep these things simple _Emergency-bracelets are being used -fall detector technologies are hardly used (e.g. you wear a belt that realizes if you tumble and sends a signal that somebody fell. There is also the possibility to use cameras for that but many people don t want that and this is still very expensive. These things will become prevalent but it will depend on the price. So apart from usings i-pads there is not much happening. people are documenting their working hours, the condition of the patient or that somebody needs meals on wheels. I don t think they order things online, yet. There is a special shopping service, there are people who bring food to homes. Home workers don t come every day. Some of them have to help the patients with taking their medication but many don t come every day. Pilot projects -we supported projects like measuring your blood pressure with a device, the figure is sent to a portal that a doctor can look at or he/she looks at blood sugar figures. If the doctor sees that something is changing, he/she can contact the care worker. This is still rare but it will definitely be getting more. -an example: think of rehab centers in the provinces, after a 3-4 week rehab, data are sent regularly to a doctor. But these are pilots at the moment. This is the future and the number of relapses goes down if data are sent regularly. 178

179 Theme 2: Care receivers needs _social needs are very important: many old people have to see a doctor very often in order to feel save. If you know that a doctor looks at your blood sugar figures every day people could feel much safer -communication and social issues is the most important subject, especially for immobile people. - food deliveries are also important, but people who are still mobile should do it themselves because they need tasks. -there will be IT-solutions for staying active mentally, playing games or studying a language, some kind of e-learning for old people. In order to stay active you have to keep trained. -relatives need the feeling that everything is okay. They need accessibility on the cell phone in case granny falls so they are getting informed and are reassured. - protection devices make sense in case the oven is still on or the tap is running. IT that can be used by old people themselves or IT where support is needed: -after some kind of training many products can be used by the patient him/herself -if we talk about medical things like getting an injection etc., support is necessary. All devices that are outside the body and don t touch the body can be used by patients. It is very important that patients can always call somebody if something is unclear. Acceptance of IT or IT based services/activities: -This differs a lot. I wrote a paper about the acceptance of the electronic health file (ELGA) for my master degree. I was dealing with the differences between the city and the country. I found out that especially people over 50 in the country don t use ICT at all. Many times they have no access to a computer and don t want to deal with it. They say that their GP should do that (use ELGA) or it won t pay off. Acceptance depends on how much you re interested in new things. ELGA is useful, I will be responsible for my data as a patient. I will decide who gets access. When I enter a doctor s practice and hand over my e-card I have to approve to give access to my personal data. If I want a second opinion I won t allow access to the 179

180 first diagnosis. People in cities are more open to give access to ELGA. I found out that people are critical but basically open for it. ELGA makes sense, do you remember when or if you had the measles as a child or when you had a vaccination? This will improve treatments, access to data will be easier. Theme 3: Digital skills for care workers and caregivers As far as I know there are no qualification needs in IT, yet. This is not written down in care worker programmes, maybe for nurses but not for care workers. It wouldn t hurt to offer a kind of class about what s on the IT market, what is there in the profession I will pursue. I don t know about any IT competencies that are asked in the care sector apart from nurses maybe. There is the Computer Driving License, you could do that. These would offer the most important fundamentals. This is the only thing I can think about. There is nothing for the care sector, yet. Important IT skills for care workers: -being able to use a computer (Windows, saving files, retrieving things, writing s, writing a documentation, excel is too complicated) -Internet skills : -being able to order something online Basic e-health knowledge: knowing special software about measuring blood sugar or blood pressure. People will have to be trained in a special product. For this you sort of have to be able to use a computer. I cannot think about any additional useful products at the moment. Comments, any other information: 180

181 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Arcola Research UK Reporter (+ Damian Hayward address): Date of interview: 01/11/2012 Place: NATIONAL HOMECARE COUNCIL - SCOTTISH CONFERENCE held at COSLA, Verity House, Haymarket Yards Edinburgh Duration: Name of respondent: Richard Stoddart DH attends conference and conducts a series of interviews with delegates and speakers as well as running a short lunchtime focus group with 3 key speakers at the event (see separate note) 30m Institution / Position: CM2000, Sponsors of the NHC event. CM2000 is Scotland's leading monitoring provider, working with 9 councils across Scotland and 40 throughout UK. Richard Stoddart is system implementer at CM2000 and attends the NHC event with Brian Brown, Business development manager who gives a presentation together with Ross McGaw (service manager) and Wendy Thompson (Occupational Therapist Development Facilitator) from Dumfries and Galloway Council where the system has been implemented (see separate completed template) Field of expertise: Extensive documentation provided in digital format is attached and contains details of the technology and services provided by the company. See also The core business of CM2000 is to provide real time monitoring of care workers activities using landline monitoring (further details below). Brian Brown CM2000 Business Development manager says 'We are working with Councils across Scotland to deliver efficiencies and more person-centred care using the latest monitoring technology.' 181

182 Self Directed support bill means, according to Public Health Minister Michael Matheson the Scottish Government has 'an obligation to ensure that care is both of the highest quality and as flexible and responsive to individual's needs as possible.' (from CM2000 publicity material) Theme 1: Current experience with implementing digital skills and ICT in care work Richard Stoddart explains that CM2000 principle service is real time monitoring of care workers activities using landline at present. The respondent explains how ithe system works stating that the care worker dials an 0800 number on arrival and then on departure. These events are logged and the activities over a period can be assessed. This is the core service provided though the technologies being used and developed extend beyond that as Brian Brown explains in the presentation later. The respondent refers to ample information provided in electronic copy which provides an overview of the technical specifications of the software being developed and in use. The software in use is also explained in the presentation and the architecture can be seen in the technical specification material provided. The system is in use across Scotland and rest of UK: in Scotland there are 2 call centres servicing the care sector and 80 across the UK. The system is based on real time tags logging in and out. Theme 2: Care receivers needs The duration of the visits may vary depending on the type of visit; they may quite often be relatively short and can be checked from the statistics gathered by the system. At the moment the systems in place chiefly monitor the length of the visits. Monitoring of outcomes is a functional capability of the system that is being worked on at present. Dumfries and Galloway council is a major client and its experience with working with the system is presented by Brian Brown, the Business Development Manager and the two delegates from Dumfries and Galloway, Ross McGaw (service manager of D&G Council) and Wendy Thompson (Occupational Therapist Development Facilitator, D&G Council) There is a quality control element built into the system as well as a clients portal where, for example, family members are able to check on whether or not visits have taken place and if they are at the correct times and duration etc. Delivery is monitored and budgets can be managed with the software. As demonstrated by the documentation and mentioned in the presentation the software has functionalities which include a 'mileage wizard' to assess that mileage claims are being made correctly. The implications for making substantial savings in the cost of care provision, particularly in more remote areas, are clear. 182

183 The respondent accepts that it takes time for care workers to get used to using the system but states that in general smart phones are being used more and more by frontline care workers. CM2000 also uses, and is investigating further uses for, RFID and mobile technologies. QR codes are not currently being used because they are easy to copy; and the same goes for location data. The predominant use is with logging events and currently 1.5m events per week are being logged on CM2000 systems in use. The only interaction the care receivers have directly with the portal is through the clients portal which provides a visible representation of the level of service. If the care receiver has any concerns, perhaps because they cannot remember having a visit, then the family can check on details online. These functions are built into the system and further details can be found in the material provided. Theme 3: Digital skills for care workers and caregivers As far as skills and training are concerned CM2000 run courses to train the trainers. The respondent feels that what is delivered meets the needs of the clients and their carers. This can be demonstrated by the increasing use of the systems and uptake (see documentation). Comments, any Material provided at the NHC Scottish Conference held in Edinburgh other information: on 1 November 2012 consist of the following files: 0078 Monitoring 4pp.pdf 0143 Finance Manager AW_4.pdf 0164 Quality Web Portal.pdf 0165 Service User Portal AW.pdf 0166 Scheduling_V3.pdf 0171 Brokerage Module_V2.pdf 0245 OLM Newsletter_AW.pdf Brochure_V2.pdf Business Case For Electronic Monitoring AM.pdf CM2000 A4 4pp SpringSummer Council Newsletter 2012 v3.pdf CM2000 Scottish ADSW Newsletter_2012.pdf CM2000 Spring-Summer Newsletter 2012 v2.pdf Devon Case Study_efficiency Savings.PDF cm2000 outcomes.pdf 183

184 cm2000 workforce solutions.pdf these files are contained in CM2000-documentation.zip file attached see also CM2000 website at Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Arcola Research Country: UK Reporter (+ address): Damian Hayward Date of interview: 26/10/2012 Place: Telephone interview Duration: Name of respondent: Peter Beckett M: S: peter.kitnet 30 minutes Institution / Position: Keeping In Touch Network Ltd S: KeepingInTouchOne Peter Beckett is Managing Director of Keeping In Touch Network Ltd Field of expertise: Peter Beckett has been working in ICT for the whole of his working career spanning 20 years. Personal circumstances meant he was involved in the care of elderly relatives for 2 years and, as a result of his experience, he set up the Keeping in Touch Network as a way of using web-based ICTs to combat loneliness amongst older people at home. The service was launched a year ago and the core service is to provide companionship. Proof of concept has been carried out and the service is involved in a pilot scheme being run by Aid UK. 184

185 The service provides companionship by 5 trained staff (companions) to around 20 users currently. The intention is for the service to be grown rapidly to reach a much larger audience. The 'companions' are seasoned individuals in their 50s and 60s who bring their life experiences to the job and have a clear understanding of the needs of the service users. Theme 1: Current experience with implementing digital They may or may not have previous experience in care work and their training is done in-house; they are all individuals with a lot of common sense. The role that ICTs can play in providing care support for older people at home is important and is increasingly so as resources are becoming stretched and 'people are having to think smarter rather than skills and ICT in care harder'. work The respondent feels that the technology needs to be harnessed rather than ignored. There is a reluctance amongst older people to embrace new technologies, but when they do the majority of them enjoy the experience. The situation is changing and this generation will, in all likelihood, be the last generation that have not used computers or had some experience of using them. ICTs, including internet enabled TVs, will open up the arena as far as combatting loneliness is concerned. Keeping In Touch Network care workers, or 'Companions', work remotely using online technologies such as Skype and to communicate with the service users. The Companions prefer to communicate face-to-face with their customers so the use of videoenabled Skype calls is preferred to communication. 185

186 There are elements of home care provision that could be introduced in the future through the service provided by KIT such as online medical checks and other simple virtual consultation activities. In order to make this happen the service users just need a broadband connection and an Ipad, Tablet Computer, PC or webenabled TV. The respondent does not feel that there are any significant challenges in terms of privacy issues etc and feels that the end user can see who is calling and make a decision on whether to answer the call or not. It is very much a customer-driven service. In order to be able to introduce ICTs to a wider audience and in different scenarios of use, there needs to be a change in 'service awareness' and once people become familiar with the technologies then uptake will reflect the confidence in these new technologies; in the same way that Skype has become an increasingly popular means of communication. As far as security is concerned, particularly in relation to older more vulnerable members of society, the respondent feels that people can be led astray if they want to be regardless of the technology at their disposal. Technology can make things happen and that is what is is there for; and the respondent feels that the benefits far outweigh the disadvantages in this respect. Theme 2: Care receivers needs Currently ICTs are being used in the following ways to meet the needs of care receivers who receive care at home: screen-based internet, Tablets, PCs, TVs etc. These are used for services delivered by KIT namely communication and companionship and by care receivers themselves for a number of lifestyle-based activities such as shopping, downloading movies, etc. Additional needs that could be met with ICTs might include participation in user groups using conference calling technologies. At present this may be limited by lack of knowledge or desire but the technologies are available. The respondent advocates the use of free or low-cost solutions such as Skype which can allow 3 to 5 people to interact comfortably in a conference call rather than more expensive proprietary software such as Adobe Connect which he feels is far too complex for the users of KIT services in any case; though at an organisational level there is considerable scope for using sophisticated web-conferencing technologies etc. 186

187 Theme 3: Digital skills for care workers and caregivers The main problems and disadvantages for care receivers of using services involving digital technology is reaching the service users in the first place. The hardest thing is the ability to find the customers. They are often people who feel stigmatised by feeling lonely, they are often independent and proud individuals and this is stopping them from accessing the service which leads to increased isolation. In addition to that, later in life people become less willing adopters of new things and quite often tend to stick with what they know. With regard to digital skills for care workers and caregivers the respondent explains that the people that work for the Keeping In Touch Network are 'social interactors' who are put through an in-house education process which includes a lot of common fundamental basic skills in ICTs and communication technologies, in particular Skype. Training is delivered in a one-day workshop directly with workers (not online) and the modules are continually being updated. It is an ongoing process and also involves monthly reviews. There is no formal accreditation or certification and all training is done internally; the care workers delivering the service provided by the Keeping In Touch Network are required to attend the workshop but as the respondent says 'how they do the job is the real proof.' Core digital competences must include communications technologies as well as office-based ICTs for administrative purposes. The respondent is happy with the digital competences possessed by and provided to the care workers currently employed by KIT. He feels that the emphasis on the importance of competences, courses, certificates and qualifications can sometimes get in the way of good human interaction. The companions working for the organisation are all people with a considerable amount of experience who 'instinctively know what they are doing.' Comments, any other information: Increased legislation with requirements for getting things rubberstamped and so on can be counter-productive and much of the service that the 'Companions' provide at KIT down to common sense. The Keeping In Touch website can be found at 187

188 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Arcola Research Country: UK Reporter (+ address): Damian Hayward Date of interview: 25/10/2012 Place: Telephone interview +44 (0) (0) Duration: 30 minutes Name of respondent: Debbie Sorkin are.co.uk Institution / Position: Field of expertise: The National Skills Academy for Social Care (NSA) re.co.uk Acting Chief Executive The central remit of NSA is to work with care providers and employers round the UK in the adult social care sector and accordingly has expertise in how ICTs are used by care providers. It has been involved in such projects as Get Connected coordinated by SCIE connected/index.asp Much of NSA work involved going round employers and they have a very good idea of how ICTs are being used by managers, front-line staff, other care providers and service users. Theme 1: Current experience with implementing digital skills and ICT in care work Debbie Sorkin has been with NSA for three years and prior to that was with the Royal Town Planning Institute and before that Tavistock Institute of Human Relations. With respect to the current landscape of ICTs and care provision and how information and communication technologies are currently being used in the field of home care, the respondent is keen to point out that not all care provision in the home relates to older people and this group represents roughly 50% of the total. ICTs can play an important role in providing care support for older people by enabling them to be connected by the use of skype and s etc. These are both cost-effective technologies. Assistive technologies can be helpful in cases involving early-onset dementia for example and may include devices and cameras alerting carers remotely that the subject is, for example, 188

189 leaving the house late at night which may represent a risk or has suffered a fall. These technologies have been patchily adopted; this is partly to do with structure of provision. They are often used in isolated situation and cases and often employers are not aware of the technologies available. Generally the level of awareness of how these technologies can help is not well-understood. Many of the care providers are SMEs and they do not all have websites and those that do, often have quite basic ones with little interactivity etc. There is a lack of understanding even amongst larger companies of how to make best use of websites etc and in smaller companies the lack of funding and understanding together with the investment of time required to really make the most of websites and web-based technologies means the potential of these technologies to play a key role in home care provision is not realised. With regard to staffing and reductions in time available the respondent refers to Cordis Bright quarterly services at aluation.php and publications at Typically ICTs used in day-to-day care provision by front-line workers may include the use of tablets and smart-phones to update changes in situations in real time; they may be used for record keeping, other changes in the situation of the care receiver and notifications of all sorts. Skills required by a care worker would include the ability to use tablets etc for these purposes and also conduct web-searches and so on. ICTs could further support care workers in their work in case recording etc if their use was more widespread. Expansion of the use of existing technologies is what is required; large providers need to adopt these technologies and they should become the norm rather than the exception. Theme 2: Care receivers needs Information on these systems needs to be more widely available: ie what is on offer, how it can be used to increase productivity etc and the savings that can be made in terms of time; which would allow more time for visits etc. Information and communication technologies are currently being used to address the needs of care receivers in the following ways: they are used to regulate the care receiver's own care; to obtain information about medication etc; for alarm systems online; as appointment reminders etc. Skype and are used to keep in touch and establish and maintain connections with social groups; and to combat isolation is a general sense. ICTs have an important role to play in improving the quality of care in the future, but more significant perhaps is if they are not widely adopted. There is a real danger of isolation if ICTs are not universally adopted, particularly in view of forthcoming changes planned for the welfare system in the UK. In April 2013 Universal Credit for people looking for work or on a low income is due to come into 189

190 force, replacing 6 benefits with a single credit. (See There will be a requirement to fill in online forms to receive benefit payments and those people without access or the skills to do this will be further disadvantaged. The respondent points out that the Shaw Trust, a national charity which supports disabled and disadvantaged people to prepare for work, find jobs and live more independently, has found that 3.91m disabled adults have never used a computer. (see This change to the welfare system is yet to be implemented and, given the potential for increasing exclusion of non-digitally literate people, it may prove difficult to get off the ground as an online system. Theme 3: Digital skills for care workers and caregivers Over time ICTs will become more widely used in social care and it is clear from the experience of projects such as Get Connected ( that where IT has been introduced in the care sector, uptake has been good. The respondent feels that the level of uptake and adoption of ICTs in the care sector depends to a great extent on 'provision, imagination and demand'. The respondent felt that digital skills are reflected neither in care workers qualifications nor competences. 'Most care workers are probably taught ICT at school and there is an assumption that young people know about computers and digital technologies'. People are keen on training and NSA have found that 96% of managers have taken non-mandatory training, in many cases paying for it with their own money. Many have taken part in online training activities. The respondent feels that it would be good to make ICT skills a core element in care worker's training as it forms an intrinsic part of the skills required by care assistants, team leaders and indeed most of those involved in care provision. It forms an integral part of how they do their jobs. The respondent does not have a view on informal caregivers but does state that the digital competence framework should be analogous to the framework for professional care workers. There are obvious practical requirements such as the necessity to enter accurate information into a table regarding medication for example. This means that it is necessary for the care worker to be able to use such software as excel spreadsheets etc and to accurately input data. It would also be useful for Care workers to be able to use databases (such as Access and/or open-source equivalents) as integrated care work means that data is held on multiple service users; accessing, updating and manipulation of the data is required and workers should be able to read and use the 190

191 information from a common source. Comments, any other information: The respondent suggests referring to The Guardian Social care network in additon to the links provided above such as Shaw Trust, Cordis Bright, Get Connected etc ( Further references provided later: and-beyond-revolution-not-evolution Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Arcola Research UK Reporter (+ address): Damian Hayward Date of interview: 08/10/ dhayward@arcolaresearch.co.uk Place: Telephone interview + 44 (0) Duration: Name of respondent: Jennifer Bernard 1h05m Institution / Position: Social Care Institute for Excellence nected/index.asp Managing and consulting director of Get Connected project (see Get Connected Field of expertise: Background in social work and social care; work in social services; working with NSPCC; ran city and guilds qualifications; last five years freelance consultant; phd. Also see Get 191

192 Project overview attached) Connected project information and SCIE website. Theme 1: Current experience with implementing digital skills and ICT in care work With regard to the role that ICTs can play in providing care support for older people at home the respondent says that SCIE start from a slightly different place by emphasizing importance of people having access to IT, whether in home or nursing homes. They look at benefits for users and staff. Discussing Get Connected grants, the respondent states that 12m of funding was provided to 1242 applications from small care providers; this was after having received 3 times as many applications for funding see attached impact assessment luationreport.pdf and details on website Many small care providers use ICTs for administrative purposes; the use is limited so the organisation wanted to improve access in order to increase staff benefits of using ICTs. The respondent's view is that all social workers should have access and be able to use IT. There are two main areas of benefit: professional development and careers of staff and benefits for service users and care receivers. Typically today's care workers are using ICTs for admin, menus, accounts etc, but hopefully funding by the Get Connected project is changing the balance; the effect of this funding will be known in due course. Domiciliary workers help with practical things like online shopping; reminiscence work (using maps, music, films, school records, photos of work place etc); in one project people with learning disabilities have 'had their social lives transformed' by being shown how to use BBC I-player and ITV-player etc to view their favourite programmes after normal transmission times. Small things change the way care providers are viewing role of ICT in day-to-day care. ICTs are also being used to maintain contact with family and friends using Skype etc; digitising of photo and music collections; etc. Indications from the project have shown that the impacts for some of the care receivers are 'profound'. There are certain tasks in a care worker s typical day that require them to have skills in the use of ICTs such as working on care plans etc. 192

193 Some say portable technologies allow them to share plans with co-workers more efficiently; they are used for booking appointments; also reminders, prompts etc. The outcomes of the funding in the Get Connected project have been carefully researched; impacts have been assessed (see report) and they suggest that much depends on the approach adopted by care providers: if the work is task-centered the technology (presence or absence) is irrelevant; if it is focussed on the person receiving the care, the technology has a greater role. Researchers have identified that managers' attitudes were important. (E-readiness MORI reports on the state of availability and use of IT for e-learning is also a useful reference document) ey2010.pdf ICT could be further used to support care workers in their work in a number of ways and Get Connected is hoping that the regulator can be persuaded to ask people to use ICTs; there is no requirement at present. The use of ICTs is not linked with care outcomes at the moment. The respondent feels that the key thing is access to ICTs; increasing access and making it more flexible eg with efficient WIFI networks. In this way the management in some smaller care providers can be bypassed and the equipment can be taken into homes by front-line workers. The respondent also thinks that local authorities should take a more active role in promoting the use of ICTs in care provision. A sister project, Digital Unite (see has, with the support of Get Connected, been championing the idea of normalising access and use of IT in sheltered housing etc (see report); Peabody homes are setting up wifi networks in all housing. The benefits can be considerable not only for the care receivers themselves but also for the family and carers; it means, for example, that family members are able to logon whilst with those receiving care, thereby encouraging younger members of families to spend time with elderly relatives etc. In hospitals with WIFI there are more options for visiting arrangements; more time can be spent together and activities requiring internet connection shared. When the person receiving care needs to rest, the visitor can remain and work online for example. Very often the degree of uptake of ICTs in places where they are not used currently is about individuals driving the idea forward about the importance and potential role of increased access to ICTs and use thereof. With regard to the problems and challenges that would need to be 193

194 addressed to make the use of ICTs more widespread in the care sector, the respondent feels that: it is not so much to do with expense (technologies are getting cheaper and wifi infrastructure easy to set up and maintain) but more about attitude. 'You have to believe that it will make a difference' The average grant given out by Get Connected was 10-11k and would typically pay for installation of wifi, plus tablets etc and cheap or free software. The respondent is passionate about the importance of using simple technologies that can be configured to individuals' needs at low cost and is not keen on the idea of expensive bespoke hardware solutions etc. Touchscreen tablets are a useful recent development, as well as increased use of free and open source applications and software programmes. Theme 2: Care receivers needs Commitment to continuing increase in the use of ICTs in care provision is slow burning. But there is always an option to regulate. Commissioners of care services are asking more about the use of ICTs. At an individual level people working in the care sector are not always confident and do not feel equipped to use ICTs. It is a question of prioritizing the use of ICTs. ICTs are currently being used by people who receive care at home in the same way as anyone might use them eg for online shopping, communication etc. Different cognitive or physical conditions mean different uses of ICTs. Differing circumstances would obviously mean a variety of uses: some care workers may use them to develop and monitor care plans; some care receivers use ICTs to look things up things on the internet (condition, medication, care and therapy); some use computer technologies for planning social and leisure activities. Collectively organising trips and outings can lead to a richer experience when researching facilities, itineraries etc online. In one project funded under the Get Connected programme, care receivers with profound disabilities were given programmes on USB sticks to carry around. The respondent mentions the work being done at the Rix Centre at East London University. Additional kinds of care receivers needs could be met by using ICTs but often are not. The respondent mentions the fact that much of the equipment designed to support care receivers' needs tends to be expensive specialist equipment (hardware) and not enough emphasis is placed on finding low-tech solutions to these needs. Touchscreen technologies are useful and tablets are useful low-cost solutions; free applications to produce custom-made QRs (quick response codes) are being explored for the potential they have in home care scenarios. They could be used effectively to label things and recover forgotten words etc for some people with 194

195 memory problems. Quick response codes can also be used in a wide variety of circumstances and attached to blood pressure monitors etc. The respondent has worries about the introduction in the home-care sector of expensive closed-source 'black boxes' that would be out of reach of most patients and caregivers. Free software and easily-available and easy-to-use hardware like touchscreen tablets and desktops coupled with a good WIFI network are important. The kinds of digital technology that could be used by care receivers themselves, and those which require a care worker s assistance depends on the degree of disability: those with physical disabilities will be able to learn how to use ICTs over time with the right support; those with cognitive disabilities will have greater difficulty and a greater need for care worker's assistance. Sometimes it is just down to confidence. The respondent points out that sometimes care providers feel they can't sustain the investment in ICT. Sometimes the management will be suspicious about what people will get up to (shopping etc) when they should be working; sometimes co-workers are resentful as they feel that sitting in front of a computer is not 'real' work. It all depends on how one conceptualises about what care is about: 'Just sitting with a patient watching an online video can be a valuable intervention.' Often though the staff just do not have the skills necessary; there are doubts about confidence of users; etc The MORI poll data suggests that staff feel more confident than the managers give them credit for: see It is often about the individuals driving the use of ICTs (Digital Champions inspiring family carers for example) Multiple benefits for care receivers of using services involving digital technology are discussed above and identified in impacts documentation actevaluationreport.pdf For doing the ordinary day-to-day things, ICTs can work well. Theme 3: Digital skills for care workers and However there can be problems with care receivers using services involving digital technology: sometimes families can be skeptical and it can be distressing when a cared-for person wishes to get involved in using ICTs but is discouraged by family members. Family dynamics are important. Regarding how digital skills are reflected in care workers qualifications, the respondent makes the following observations: It does not form part of the curriculum, though sometimes care workers are 195

196 caregivers required to fill in an electronic portfolio. In some cases content is delivered online. Use is incidental rather than direct. Digital skills for care workers are not currently accredited and certified. There are some new qualifications currently being developed by Digital Unite; these are for Digital Champions and are intended to encourage people in the use of ICTs. They will be accredited by City and Guilds. Attempts to create links with existing qualifications are being looked into but at present certification are optional. Core digital competences that all care workers should have include the ability to: use the internet for searching; use ; and use software required to complete care plans and records; they should be comfortable with resources to support in leisure and communication activities. Additional digital competences that it would be useful for care workers to have would be more of the same, but the emphasis should be on being able to adapt and use standard kit and free software; as well as less commonly used programmes (speech into text etc) Informal care givers should have access to the professional framework if they require it. Professionals should be equipped with the kind of skills required to work in care planning etc. Informal and professional skills base should be pretty much the same. Comments, any other information: As well as the references above and the documentation attached, the respondent recommends two publications coming out of the Get Connected Programme: 1) a guide to using IT for care workers (an outline publication and in booklet form) _Connected_to_elearning_for_social_care_providers.pdf and 2) A guide to using IT for people with dementia (due in early November 2012) with a detailed research document underpinning it. 196

197 Carer+ Report Phase 3: Semi-structured interview transcript Partner Arcola organisation: Research LLP Country: UK Reporter (+ address): Date of interview: Place: Damian Hayward 18/10/2012 Telephone interview Duration: 45m Name of respondent: Sara Dunn unnassociates.n et Institution / Position: Sara Dunn Associates dunnassociates.net Lead consultant and project manager Field of expertise: Providing strategic consultancy and evaluation services to health, social care and educational bodies. She has developed particular interests in research utilisation and knowledge management for practitioners. see CV_webversion.pdf see also Theme 1: Current experience with implementin g digital skills and ICT in care work Theme 2: Numerous consultancy and project management roles in projects for organisations such as SCIE, NICE, Skills for Care, etc see Sara Dunn was formerly a publisher involved in electronic publishing for 15 years. She became an independent consultant working in health, social care and environmental fields; and her company provides 'consultancy services in communications and knowledge and information management with a focus on clients in the public and not-for-profit sectors, particularly in health, social care and education'. Her work involves use of digital technology to support practitioners in the main rather than service users, though she is currently involved in a project with partners working with IT in dementia which targets service users as well as practitioners. She has a Masters degree focussing in accessibility in virtual learning environments. How ICTs are being used by people who receive care at home is not clear. 197

198 Care receivers needs There is a danger that the technologies for use by older care receivers are being designed by 'digital natives' and are technology-led innovations which sometimes have less to offer the end users than people-led technologies. There is also a suspicion that increased use of ICTs is just another way to reduce human contact hours and therefore costs in the care budget. There is a pervasive sense that services are becoming depersonalised by increasing emphasis on ICTs. Care receivers' needs that can be met with ICTs include, amongst other things, communication and support; but this must not be instead of human contact but in addition to it. This will reduce isolation and increase a sense of empowerment; there is a basic right to being a digital citizen and everyone should enjoy that right whether young or old. It is clear that the danger of not having access to these technologies carries a risk of being left out: people are encouraged (by TV etc) to engage in activities such as ing, tweeting, etc. It is everywhere and those unable to join in feel alienated. The other side of the coin is the fact that some social networking technologies are distrusted and so some older people may not feel that these things are missing from their lives. There are of course serious issues about older people, particularly with early dementia, engaging with social media and the potential dangers of exploitation are obvious. There have been recommendations to care staff setting up s for older people in their homes, which stress the amount of extra work that may be involved in administration of these accounts. This undoubtedly puts people off adoption of these technologies. By way of example, there are some really useful simple free apps that can be used to good effect with people with dementia, such as drum kits to use with touch screens. The fact that they are free is both good and bad because they invariable have ads embedded. They can have a good simple interface, but then have flashing orange banners advertising bingo, for example, that can be confusing to someone suffering from mild dementia and can lead not only to cognitive overload and confusion, but also to potential safety issues if the user clicks on the link. Use of ICTs with these, and many other, care receivers must be supported if they are to be promoted and exploited to the full. Theme 3: As far as front-line care providers are concerned digital skills do not play an Digital skills important part in their daily work. It depends on how a 'care worker' is defined; for care most are front-line workers whose duties typically involve washing, preparation of workers and meals etc. They have very little contact time (some figures suggest as little as 23 caregivers minutes as a typical visit duration in UK) and the requirement for skills in these areas is not great and the time to engage in anything other than timely access to information by using a smart phone for example is limited. Managers may be using ICTs more than front-line workers for care plans, 198

199 ordering or admin tasks; but a care-worker in direct contact could easily get through a working day without resorting to using ICTs at all. This is not to say that there is no potential and the ability to access timely information about medication for example is useful; this can be easily done using smart phones or tablets and would otherwise involve phoning the management to request information. Just-in-time access to information could support the caregivers day-to-day work and the use of touch-screens by care receivers for entertainment and communication activities may support home care provision. The current situation with contact time being so limited means using ICTs is a luxury that can be ill-afforded; some younger care-workers may use smart phones but no more probably than they would outside work. There are people working in the care sector whose role involves the use of ICTs but for most care-workers it is not the case. Use of ICTs in daily care is 'almost zero and getting worse'. The challenges and problems that would need to be addressed to make the introduction of ICTs in home care widespread in the future are: the lack of time at present for visits, staff competence issues, hardware and software problems and costs, managerial buy-in and so on. It is important that the technology does not adversely affect the amount of human contact that the elderly person receives. Currently digital skills do not appear to be reflected in the qualifications that care workers on the front line have. Registered managers training requires that they keep abreast of legislation and, in order to do this, digital skills are required to access these sources of information. There is a feeling that ICT skills should be treated in the same way as basic numeracy and literacy skills. Frontline workers at present are probably not required to have any ICT skills. The respondent refers to the common induction standards produced by Skills for Care organisation. Standard 1 item 4 makes explicit mention of electronic systems. Some additional implicit use of ICTs e.g. under data protection and reference to various web-based tools. See and pdf attached below She cannot provide any additional information regarding current accreditation and certification of care workers in the UK. Core digital competences which would useful for care workers would be entry level ICT and the ability to use and browse the web. 'More than that and you turn into an IT worker rather than a care worker'. Any additional competences means there is a danger of isolating that from being good care workers; the skills should assist in the execution of tasks and 199

200 should not be separate to good care work. There are quite a lot of migrant workers in the care sectors and there is a requirement to have good basic literacy and numeracy skills. IT skills could be treated in the same way. As far as informal care givers are concerned and whether or not a different digital framework would be appropriate, the respondent believes that the priority is very low. If the person delivering the care is into IT, all well and good, but it is not the most important factor to good care. There are some online support groups for carers and peer support for carers which can be useful. Comm ents, any other information: Common Induction Standards attached (pdf) CIS_with_glossary_June_2010 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Arcola Research UK Reporter (+ address): Date of interview: Place: Damian Hayward Interview completed by respondents following series of calls and s and sent 19/10/2012. Redacted and placed into template 20/10/2012 dhayward@arcola-research.co.uk Duration: Name of respondent: Diane Buddery Diane.buddery@ skillsforcare.org. uk Helen Simpson Helen.simpson@ skillsforcare.org. uk Institution / Position: Skills for Care. Diane Buddery; Project manager; Policy and Innovation Helen Simpson; Programme Head, Skills for Life Field of expertise: Diane Buddery; leads within the organization on the development of all strands of work to support unpaid carers. Also leads on workforce development of care workers and assistive technologies. Helen Simpson; leads within the organization on all aspects of the Skills for life programme. Theme 1: Current With respect to the current landscape of ICTs and care provision 200

201 experience with implementing digital skills and ICT in care work and how information and communication technologies are currently being used in the field of home care, the respondents the provided the following information: Regarding the role that ICTs can play in providing care support for older people at home; there are many possibilities from practical help with the activities of daily living through to enabling people to have a better social life. Largely, these are very under-utilized. Older people could be using the Internet for researching, booking & managing a wide range of support services.technologies can also prevent loneliness - being connected to friends, family and outside world. Regarding the typical care worker's day and the ICTs being used, the respondents made the following points: Mobile phones are used for general communications. Care workers mostly use pen & paper for recording but mobile electronic recording systems could be much better. Helping the older person to use any Assistive technology where in place. Not much else Specific tasks in a care worker s typical day that require them to have skills in the use of ICTs may include: Calling in to work, checking/changing rota. Case recording if electronic system in place. Helping the older person to use any Assistive technology if in place. Helping older people use computers, phones & internet to enable choice, convenience etc. Theme 2: Care receivers needs ICT could further support both care workers in their work in case recording. This could be done more efficiently and live if technology were used instead of writing. Eg. Medication dispensing. It would also allow them to send live updates to base and older people if running late; assist in arranging other/additional care & support 'there and then' whilst they are with the person needing that support; and also helping older people keep in touch and manage affairs electronically In order to introduce ICTs in these areas the following is needed: ICT support and advice for managers to help them choose the right systems & suppliers, and set up and manage change; and introductory training for end users. The problems and challenges that would need to be addressed to make this possible include: skills & attitudes of managers and employers; lack of appropriate advice suited to the specific needs of social care businesses; and capital investment costs of equipment. The respondents comments on how information and communication technologies (ICTs) are currently being used to address the needs of care receivers, and how ICTs might be used in the future to improve the quality 201

202 of care provided were as follows: ICTs are currently being used by people who receive care at home as: a lifeline to get info, to book appointments, people, submit claims, access a range of services, contact family/friends & prevent isolation. Assistive technology is being used also. The following additional kinds of care receivers needs could be met by using ICTs: Broadening these benefits to those who aren t currently online or don t have digital literacy. If they were digitally competent and could therefore assure safety, they could access online services such as banking, benefit claims, appointment booking, shopping etc. Asking for extra help and support; support for informal/family carers; and access to a wider range of assistive technology. The kinds of digital technology that could be used by care receivers themselves, and those which would require a care worker s assistance really depends on individual circumstances and needs. Regarding care receivers reactions to services involving digital technology, the respondents felt that most of them would expect it and think it completely normal and acceptable and that they probably think it bizarre how behind the times the care sector is. The respondents felt that this view will only grow as the present generation becomes the service users of tomorrow. The main advantages for care receivers of using services involving digital technology are as follows: empowerment, control and increased access to all types of services, support and information. For example, being able to read their own case records or check appointment schedules etc. The main disadvantage for care receivers of using services involving digital technology is digital exclusion if people don t have the confidence or skills to engage with it then they could be further alienated. Theme 3: Digital skills for care workers and caregivers 'What if care and support became technology-dependent and then the technology failed, leaving people without essential support?' With regard to how digital skills are reflected in care workers qualifications the respondents stated that: There is very little reference within Common Induction Standards and Diploma. There are new standards & qualifications projects underway around assistive technology and informatics. Functional Skills ICT level 2 is a requirement within the framework for the Higher Apprenticeship, but no ICT is currently required for other 202

203 apprenticeships. Recent survey says 56% of employers would like ICT functional skills to become part of other apprenticeship frameworks but training providers are resistant. Current accreditation and certification of digital skills for care workers is not applicable other than in new Higher Apprenticeship The core digital competences that all care workers should have are as follows: Basic computer use including word processing, and use of internet Data security & confidentiality Online safety including finance, identity theft and personal safety ATMs and automated check-outs Phones & hand-held devices NB the respondents suggest referring to ICT functional skills maybe at level 1 and the cross-sector employability skills matrix as source of competences to include in the framework (see attached Skills Toolkit produced by Asset Skills) The additional digital competences that it would be useful for care workers to have may include: How to use a range of typical assistive technologies How to learn new skills and keep up to date How to help people overcome specific access issues (eg font size, screen readers etc.) How to help people get online and use the internet safely (become digital champions) Understanding digital exclusion and how the use of digital technology can impact on care, both positively and negatively Comments, any other information: The respondents felt that digital competence framework for informal care givers should overlap with that of professional care workers as far as possible, and they may need to have extra units/sections that relate specifically to the learner s duties as an employee or service provider Skills for Care organisation is responsible for a number of publications such as the Common Induction Standards (CIS). Respondents also make reference to Skills Toolkit produced by Asset Skills (Employability Matrix) which is attached to this document. 203

204 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Arcola Research UK Reporter (+ address): Damian Hayward Date of interview: 01/11/2012 and 09/11/2012 (telephone interview) Place: NATIONAL HOMECARE COUNCIL - SCOTTISH CONFERENCE held at COSLA, Verity House, Haymarket Yards Edinburgh dhayward@arcola-research.co.uk Duration: 2h total time Name of respondent: Martin McGeady martin.mcgeady@ westerntrust.hscni. net Institution / Position: Head of Home Care, WHSC Trust Northern Ireland covering three western regions including Omagh and Enniskillen. The trust is based in Derry. et/ Field of Expertise: As head of home care in the region the respondent is responsible for home care delivery across a geographical area covering some 2000 square miles and made up of predominantly rural communities where home care is provided in the main by a workforce (district nurses and social workers) made up mostly of women of early to mid 50s with very little in the way of digital skills. The workforce amounts to individuals providing care in small rural communities to around 10,000 care receivers. The main challenges facing the Western Regions trust are the changes in the Health and Social Care sector in the area and the requirements for transactions to move towards a paperless system. Administration related to visits, mileage claims, etc are all to be done with ICTs. There is a huge challenge for the 204

205 workers in the NI western regions where there is a whole raft of older workers with inadequate ICT skills who will need to embrace technologies and changes. The emphasis is on getting these administrative tasks done more quickly. The BSTP (Business Service Transformation Programme) - see website at - deals with procurement, training, commissioning etc of care workers in the health and social care sector. The move toward a paperless system is driven by this programme. The respondent describes 'imminent radical changes' and the 'doomsday scenario' outlined by HR managers in the care sector who have indicated the need to equip the staff with appropriate skills or 'they may not get paid'. He explains that the area is rural, widespread, covering thousands of square miles meaning workers are required to travel long distances to the care receivers. He says it represents not just a procedural challenge but also practical. He emphasises what needs to be done and how ICTs can be used. Theme 1: Current experience with implementing digital skills and ICT in care work In his presentation to the delegates at the NHC conference (see attached) and in interview the respondent describes the paperless process taking place in the healthcare sector in NI and the need for skills in administrative tasks undertaken with ICTs to be provided. The presentation gives details of the structure of care provision in Northern Ireland; the roles and responsibilities of the different bodies and individual departments involved in the care provision in NI; and the political arrangement in force. He discusses Integration in Action covering the proposals for the 205

206 ISD (Integrated Service Delivery aimed at improved communication, easier access, better understanding of roles etc); the standard approach (RPA); and the Single Assessment Tool (NISAT) which is yet to be fully implemented. see The IT infrastructure in the regions and the fact that the buildings are not normally built for purpose (usually refurbished buildings) are challenges to implementation of the systems and technologies proposed by the new measures. He talks about best practice particularly with regard to the dementia team in the western area and reablement and community rehabilitation. The future 'Transforming Your Care' initiative revisits integration and proposes increased involvement of GPs in Health and Care centres, amongst other things. See Implementation-Plan-Oct-2012.pdf The restructuring across the regions in health care provision require far-reaching changes to the existing home care system. The process taking place in the Western regions regarding BSTP requirements are the main challenges facing the respondent and the home care workforce; specifically insofar as they relate to routine back office stuff and HRPTS (HR, payroll, travel and subsistence) see The trusts were told 'this is what we are planning and this is what we are doing'. The ICT to be used is mostly in administrative tasks but this does not mean it does not represent a considerable challenge. Even though some software is already in use in an ad hoc way (eg Commcare designed programmes) for routine tasks, in many other areas traditional methods are still in use. NISAT (single assessment tool) is still very new and client information is still gathered in paper copy. In home care in the regions concerned, the care providers are predominantly made up of district nurses and home care workers with low digital skills. It is quite common to go into a social workers office in a town in one of the regions and to find just a single PC in the corner of the room being shared between 5 social workers accessing HRMS for example (human resources management system). The respondent says his departments receive a range of material that combine to produce a care plan which then becomes an agreed care plan and feeds into the referral process. The process is not integrated in a single electronic system. At the moment this is mostly paper based; the aspiration being that 206

207 this becomes an electronic tool (it has been piloted but is yet to be implemented in WHSC) With regards the IT infrastructure it is set up in ad hoc way; the buildings are old, not built for purpose and most of the people directly involved with care delivery are district nurses and social workers with few digital skills. ISD (Integrated service delivery) is bringing them together in teams and there are many challenges as the staff are occupying old buildings etc. Collaboration takes place and good practices are shared using intranet etc and there are some good examples where it is working well. It is not widespread. NISAT has had regional success and it is committed to be rolled out. The respondent explains 'We have technology but it is fairly primitive. We are reliant on pen and paper; risk assessment and care plans and maintenance of the client record book are not electronic. Things have not changed for many years.' No soft copies files would normally be kept. The first step towards modernisation is through BSTP (see above) and the challenges are great. Most care providers at the 'coal face' are part time workers, many women, early to mid 50s and mostly unable to use computers. The question is how to do it and the respondent believes it depends on accessibility and availability of hardware. He says it is generally believed (by ICT technical staff) that everybody does a lot online such as booking flights and so on but this is not always the case. The problem is the accessibility of the technology; the area is geographically widespread; local people need upskilling. BSTP has practical deadlines which will be difficult to meet. At the present level of digital skills. For example the payments system relies on timeliness after 31st of month; time sheets need to go in before 2nd day of month for example in order for payroll to take this time into account for payments. The respondent envisages a situation where the few PCs available in some offices will be booked solidly for care workers to enter their hours on just a couple of days at beginning of each month. He is not optimistic that the current level of equipment provision will be sufficient for this to happen comfortably; and the lack of digital skills could further frustrate this process. Theme 2: Care He says that provision of equipment can be a prickly issue in these difficult economic times when 'even getting a new stapler can be a headache'. With respect to ICTs currently being used in care provision, the respondent 207

208 receivers needs explains that smart and assistive technologies are fairly widely used in Northern Ireland. NI received a disproportionately high investment in these kinds of technologies and as a consequence the care receivers have benefitted considerably from this. Service users are provided with staff to assist and promote the use of these technologies. But once the technologies are up and running there is really not a lot of support required from the care workers. The companies (such as Tunstall) will install the devices and progamme them and once that is done even people with considerable disabilities can be maintained at home with the right level of investment; indeed one high profile case in NI involves a quadriplegic living at home with support of a highly sophisticated technological set up. These specialised support technologies do not require the care staff to be technically savvy. Other technologies may require some encouragement by carer in order that they are used to their full potential. The respondent refers to well-known project involving a 'smart house' in Livingston run by Stirling University see pdf He discusses how more mainstream technologies can be used to good effect by citing an example of a client who is an elderly widower with dementia whose son can monitor his activities from own his home in Australia by using a simple CCTV system that has been installed for the purpose. There are many systems in use for monitoring health and alerting if the patient is sick etc. Theme 3: Digital skills for care workers and caregivers Bespoke solutions tend to encourage people to think outside the box and the cost is quite often relatively low; particularly when compared to the cost of standard care provision. The profile of the majority of the care providers and the state of implementation of ICTs in day to day activities of care workers in WHSC Trust Northern Ireland means that there are roughly 800 to 900 individuals working in the region who will need training in one way or another. Training will need to be carried out and facilities such as training suites will need to be established in locations across the three regions for the purpose. The respondent is hopeful that within 5 years the planned adoption of the new digital systems can be integrated into the working lives of the care providers in the region. The upskilling of a relatively unskilled workforce in digital competences is the real challenge facing the regions in the proposed restructuring of care provision under the BSTP and the move towards a paperless system 208

209 Much depends on the general confidence of the workers and the respondent reiterates that 30% of the workforce have no digital skills, 30% have a bit and the remainder varying levels of skill. Comments, any other information: In the year ahead general digital awareness will need to be raised amongst the workers in order that the administrative practices can be attended to with ICTs and training provided to ensure that all care workers are properly equipped for the road ahead. As well as the references above and the documentation attached, the respondent will be providing a copy of the presentation given at the NHC conference. He also participated in the focus group session. Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): EOS Educating for An Open Society Romania Date of interview: 29 September 2012 Place: Duration: Name of respondent: Maris Andra Theme 1: Current experience with implementing digital skills and ICT in care work Cornelia Popescu cornelia.popescu@eos.ro EOS office 25 minutes Institution / Position: Maltez organisation/social care expert Field of expertise: Home care Services for elderly; Generally, what do you think about the relationship between digital skills/ict and care? ICT skills play an important role in the activities developed in the home care sector because it can be seen a more efficient working time by managing databases, electronic forms, ensuring continuous communication among care workers in order to be informed and for development of the activities. In your perspective how influenced the advances made in digital technology the care sector? Digital technology has allowed that the time used for registration and recording of daily activities to be reduced. So, the effective time dedicated to beneficiaries increased considerably, increasing the possibility of continuous information and professional development and also facilitating direct communication between care workers and various institutions. Can you tell me some advantages and challenges that digital technology leads in the care area? Benefits are coming from the fact that 209

210 the work become easier by processing the information using technology and renouncing of all the records that were kept in paper format, possibility to be informed quickly and constantly about the news and laws appeared in this field, sharing experiences with other professionals, increasing the time allocated to beneficiaries, increasing services quality and the quality of life. If you have to describe a current typical day of a care worker, how do you use ICT for this purpose? Planning the activities for that day in the electronic agenda (setting the time when he will arrive to each care recipient, registering any problem appeared, shopping necessary for each beneficiary), achievement of doctor schedules via and checking the confirmation, preparing daily progress report: To note any travel that they are making according to the beneficiaries needs ((doctor, church, shopping, cemetery); Noting the problems and how they were solved; Record the notes with things to resolve for the next visit. Theme 2: Care receivers needs From your experiences which are today the typical circumstances that are making care workers to use digital technologies? Unfortunately, digital technology is little used among care workers in our country. Which are in your opinion the needs of people cared that can be answered by using digital technology? Need to have an active and creative social life, possibility of accessing public and commercial services, thus improving quality of life and reducing social isolation; the need to enjoy a healthier life and a better quality of everyday life for a longer period with the aid of technology, maintaining in the same time a high degree of independence, autonomy and dignity. In the every days life of people cared, how can be useful the digital technology? Beneficiaries may be better informed than before and thus they can assume more the responsibility for their own health, physical condition and an independent life using information that can be found on the Internet or the individual solutions offered by ICT in everyday life - reading online newspapers, electronic forums, websites and digital libraries. What types of digital technology can be used by people cared and would require assistance from a care worker? Mobile phones smart phones can be included here and personal computer or a smart device. How do you think that people cared will react to the services that are involving digital technology? Generally the beneficiaries are reluctant in their desire of using digital technology, mainly because of their low level of 210

211 knowledge. When they are face to face with the new technologies, the elderly feel in a relatively weak position due to their personal situation (income, education, geographic location, health, possible impairments), because of the complexity of technologies or mediation made by professionals (doctors, experts in rehabilitation, independent living), providers of formal and informal care services or family members. In addition, products and services often are not adapted to meet the specific needs of older users or are not adequately available, thus increasing feelings of frustration and dependency. If no action will be taken, this situation will also be true and for future old persons due to rapid technological changes. Can you describe your experience related to the acceptance of ICT based services and activities of the people cared? We found interest from beneficiaries side only after presenting the benefits that can be obtained from technological processing information, of the fact that multimedia resources are designed to reduce communication costs, to increase access to information and, in general, the speed of communication. I also explained that Internet is useful for communication, for some types of acquisitions, keeping in touch with friends and family via as a source of entertainment. Which are positive and negative sides in this situation? Often some procedures are more complicated, and if they fail at some point, the older person can feel utterly powerless, even blocked, his interest decreases significantly, and the first reaction is to renounce of using technology. As I argued above, they would benefit from an active and creative social life, thereby improving quality of life and reducing social isolation, while offering a high degree of independence, autonomy and dignity. Theme 3: Digital skills for care workers and caregivers Currently, which are the digital competences that are incorporated into care workers qualifications? Currently I m not aware that digital competences to be integrated in the care workers qualification. I don t think they are. Which are the digital competences that are taught in the actual VET programs in the care sector? In Romania, because the basic needs of care recipients are only partially satisfied, so far has not been given such an importance on teaching digital competences. There are non-formal opportunities for carers to develop digital skills? Yes, I think that care workers can develop their digital skills through self-education, but it depends very much on the age, abilities or even of the material possibilities. What skills and digital literacy you consider very important for care workers? Microsoft Office tools, databases, correspondence via , 211

212 accessing websites, electronic journals, and electronic agenda. Which are the additional digital skills you think are advantageous for care workers? Establish a communication network with other care workers and a database where to be recorded all problems encountered on the work field and also the solutions to these problems. All care workers must have access on this network so they can benefit from others experiences related to the same problems, in order to meet the needs of beneficiaries, so that care recipients to have the opportunity to participate in social and economic life and be as active as empowered citizens. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): EOS Educating for An Open Society Romania Date of interview: 24 September 2012 Place: Duration: Name of respondent: Gabriela Borș Theme 1: Current experience with implementing digital skills and ICT in care work Cornelia Popescu cornelia.popescu@eos.ro Caritas federation office 29 minutes Institution / Position: Caritas Federation/social care expert in medical field Field of expertise: Home care Services for elderly, medical services; Generally, what do you think about the relationship between digital skills/ict and care? The current trend is to offer as much services as possible through an online environment, and given the fact the work that we are doing is daily at care recipient s homes, valuable time is lost traveling from one beneficiary to another. Therefore, modern IT technology and equipment can be very helpful, because unforeseen things can occur - such as traffic jam - and the elderly are always impatient and expect that the carer worker to arrive in time. Since most of them have only traditional phone, it is quite expensive to call from your mobile phone and announce that something unexpected occurred. Of course, if both care recipients and care workers would have other media devices connected to the Internet, the cost would be much lower and would save time which could be allocated to do other activities. In your perspective how influenced the advances made in digital technology the care sector? 212

213 The home care services were positively influenced by the progress of digital technology. Currently, the reports and the statistics that care workers in our organization are doing, are made electronically. These documents are also sent to other country branches and internally (in the organization) using . With patients unfortunately we are unable to communicate by or other advanced devices. The only way to communicate with them is only landline phone calls, which is the only communication device that they have. Digital technology offers the possibility of accessing multiple programs that help better organize the schedule or inform you on different aspects encountered: as a nurse I must know everything about a product before I use it and from this point of view Internet and technology help me to be always well informed. Can you tell me some advantages and challenges that digital technology leads in the care area? The biggest challenge is the access to the new technologies which draws, in this case another challenge - the access to information and the second challenge would be motivating the beneficiaries in using them. Digital devices are portable and easy to carry - ideally suited for field work that we are carrying out in the organization. Thus, our care workers would be able to stay connected and have access to new information in short time. Communication is also more effective when using modern digital devices. An older person using these technologies is another challenge. Unfortunately not all of our elderly could use these technologies because many of them are chronically ill and this would be difficult. Those who have a better health would be interested in learning to use technology. Although at the beginning they would be reluctant if somebody will explain them with patience how these devices can be used, eventually they will be tempted to use them. If you have to describe a current typical day of a care worker, how do you use ICT for this purpose? In our case, as medical assistants providing home care, we are often facing with changes in the pharmaceutical industry. Therefore the most commonly used application is the Google search engine. Care workers need to seek new information about new medicines. On the other hand, social service department uses the technology daily, preparing reports, social surveys and essays. Therefore, the 213

214 technology is used daily to accomplish the necessary documentation. Unfortunately not all care workers in our country have this opportunity. There are many cases where because of the lack of time or funds, care workers have no digital skills. Theme 2: Care receivers needs Which are in your opinion the needs of people cared that can be answered by using digital technology? Information need is the most important need that can be answered with the aid of technology. Many of the elderly are not informed and do not know their rights. Therefore the social services offer a lot of advice and guidance on rights that elderly do have. With the use of technology, assistants and social referents can inform them more easily. In the every days life of people cared, how can be useful the digital technology? I can see a lot of benefits using the digital technology by the people cared. They are often lonely and marginalized and appropriate communication applications for their age, especially for those who are still receptive to everything that is new, could facilitate communication with family and those who are far away from them. The idea is to improve communication between care worker and the person cared and also between elderly and family - especially when they are away. Social aspect is very important and technology can remove the distance and foster better relationships with others. What types of digital technology can be used by people cared and would require assistance from a care worker? Portable digital devices with suitable applications for the elderly. Also it would be useful to have Internet connection because many of the elderly cannot afford to pay a monthly subscription to the Internet. How do you think that people cared will react to the services that are involving digital technology. At the beginning it would be a great curiosity for them to know how these devices are working. Some of the elderly would consider this a privilege. I think the main attraction would be the possibility to hear, to discuss more often with their children and grandchildren, to communicate directly with the family. Most of the elderly have families abroad, and we are most of the time intermediaries between families and elderly because there is no other alternative. Communication by phone is difficult, not to mentioning about the costs. 214

215 Theme 3: Digital skills for care workers and caregivers Currently, which are the digital competences that are incorporated into care workers qualifications? In Romania, digital skills are not embedded in the qualification of care workers or in the job description. In our organization, since the average age is between years, care workers have acquired digital skills through self-directed methods. Which are the digital competences that are taught in the actual VET programs in the care sector? Information technology is not covered by vocational education and training. Most carers who use technology have been initiated over time using technology in their daily work. There are non-formal opportunities for carers to develop digital skills? As mentioned above, on a personal level, everyone can acquire ICT skills and there are also some projects which offer ICT training. Some of them are accredited course, and certify the skills gained. But not all care workers have access to these projects and one of the factors is the geographical area in which they work. Those who work in larger cities have more opportunities than those in rural areas and small towns. Also, for coordinators is very important to develop these skills, as some institutions such as Health Insurance House, use software for making payments for home care services, and they are requiring that social services to register online all expenses incurred. What skills and digital literacy you consider very important for care workers? Those digital skills enabling them to work with databases in order to complete electronically and the personal files of beneficiaries. Also writing skills related to text and presentations. Comments, any other information: 215

216 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): EOS Educating for An Open Society Romania Date of interview: 25 October 2012 Place: Duration: Name of respondent: Ionut Alexandrescu Theme 1: Current experience with implementing digital skills and ICT in care work Cornelia Popescu Caritas federation office in Resita, Caras Severin county 30 minutes Institution / Position: Caritas Federation/social care expert in medical field Field of expertise: Home care Services for elderly, medical services; Generally, what do you think about the relationship between digital skills/ict and care? Computer and digital skills helps a lot the care workers given the fact that all the activities developed must be finalised by completing daily records, making monthly reports and databases with beneficiaries. It saves time because they don t have to write by hand and after that all this documents to be transcribed into electronic version by other person. In your perspective how influenced the advances made in digital technology the care sector? The advances realised in digital area influenced and the care sector lately, but unfortunately in our country we don t have performing equipment that can be used by the carers. Sometimes many of them are using their own computers to realise the documents they need in their work we are speaking here about young carers and those who have a better financial situation. Not all of them can afford to buy good IT equipment, generally they have small incomes. Care workers in our country are not trained to use technology and the lack of time due to a busy work schedule in care the care sector makes that many carers to not use the digital technology, especially if they didn t had the chance to learn how to use it in the past. Can you tell me some advantages and challenges that digital technology leads in the care area? The advantages that digital technology brings in the care sector are not strictly related to the work with the customer in my opinion. She brings 216

217 benefits mainly in completing all the documentation that care workers must achieve, as I mentioned above. Helps the carers to transpose on paper electronic format the achievements they have in the field so that these achievements to be visible and to able to keep a clear record of tasks performed which is an aspect extremely important. If you have to describe a current typical day of a care worker, how do you use ICT for this purpose? In the present the lack of equipment makes difficult that technology to be used daily by carers in their work on the ground. Therefore they are forced to record by hand all visits and activities performed on a notebook and usually all these documents are drown up on the computer at the end of the month, which means double work and efforts. If it would be possible to use technology every day in home care activities would be very beneficial for carers in order to achieve their daily report directly in electronic format after each visit they realise to each care recipient. So, at the end of the month all this documents will be already centralized. They would be also able to search for the information they need using the mobile equipment. Theme 2: Care receivers needs Which are in your opinion the needs of people cared that can be answered by using digital technology? The most important need is that of socialization. Elderly would like that the carers to spend as much time as possible with them and to have together more recreational activities. With the aid of the internet and IT equipment s the social need can be better achieved even in the moments when the carer is not present at the residence of the beneficiary as long as he has a computer or other device. Thus, they would communicate more often with family members or other friends and relatives. In the every days life of people cared, how can be useful the digital technology? Technology can be useful in the life of the elderly especially when we refer to the emotional side. Generally, they would like to see pictures of their grandchildren because many of them have relatives that are working abroad. Having the opportunity to use digital technology they could talk more often because they rarely speak with them due to high costs of the phone. Many of them are immobilized in bed and have no longer the opportunity to get out of the house and to visit friends or acquaintances. They could also watch an online movie or a show about topics that they are passionate about. 217

218 What types of digital technology can be used by people cared and would require assistance from a care worker? IT equipment s easy to handle as a laptop or tablets are appropriate as some of them can move out of bed only with the aid of the care worker. Other IT equipment would be difficult to use because they need to spend more time sitting and for some of them their health no longer allows this thing. Also a traditional computer would not help them very much because it would be difficult for them to use the mouse. For those with greater disability would be useful and a special software dedicated to older people with degree of disability. How do you think that people cared will react to the services that are involving digital technology. Theme 3: Digital skills for care workers and caregivers They will be very pleased by the ICT services and will look forward to be again supported by carers to use these applications. Would be for them a pleasant leisure activity, thus favouring the disappearance of loneliness and isolation. In order that they to be opened to this new change that involves the use of new technologies, the care worker must identify the sensitive side of the care recipient and which is the beneficiary s strongest motivation that would determine him to use the ICT equipment. More than 90% will accept the idea of using technology. Currently, which are the digital competences that are incorporated into care workers qualifications? From my experience I know that digital competences are not included in the qualifications for care workers especially because training curriculum does not include a module for digital skills training. Which are the digital competences that are taught in the actual VET programs in the care sector? VET programs do not include training skills, these skills are acquired by non-formal mean by most of the carers. There are non-formal opportunities for carers to develop digital skills? Non-formal opportunities exist, especially for young people - some of them have developed these digital skills over the time by working every day with computers and other devices, others were taught by friends or relatives and acquired some basic skills. Old carers not developed these skills very much, a few of them know to do some basic things on a computer - to use a web browser, music or video applications that they are using at personal level. 218

219 What skills and digital literacy you consider very important for care workers? The most important digital skills that a carer must have are those of text editing in order to prepare their reports, working with spread sheets to know to make tables for the required statistics and also Internet navigation skills. It must know which are the most important browsers, search engines and how to use them, using - how to create a mail account and how to manage it. Even equipment safety issues - antivirus installation, cleaning the equipment of potential virus threats, how to download materials related to care sector topics from certain platforms and torrents. How can use social platforms to be always connected with other people providing such services. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): EOS Educating for An Open Society Romania Date of interview: 26 September 2012 Place: Duration: Name of respondent: Ingrid Lukacs Theme 1: Current experience with implementing digital skills and ICT in care work Cornelia Popescu cornelia.popescu@eos.ro Caritas federation office 25 minutes Institution / Position: Caritas Federation/social care expert in medical field Field of expertise: Home care Services for elderly, medical services; Generally, what do you think about the relationship between digital skills/ict and care? Generally, care workers do not use technology because they don t have access to ICT equipment and internet but mostly because they don t know what benefits can bring the new technologies. Many of them cannot afford to purchase their own IT equipment s that can allow them to better develop their ICT skills. In your perspective how influenced the advances made in digital technology the care sector? I think the biggest advantage is that technology allows you to be 219

220 always informed and to be aware with everything that is new in the medical and social sector in order to offer high quality services to care recipients. Can you tell me some advantages and challenges that digital technology leads in the care area? I think the biggest challenge is that each carer that provides medical services or social services for achieving daily household activities to be able to realise without support his own electronic worksheets and daily activity reports and in this way to make the work of the coordinators and social workers much easier. Because in the present domiciliary care workers complete their activity reports by hand in a notebook, at the end of the day/month the coordinators have a lot of office work in typing all this reports because they have to monitor all the tasks. Having mobile equipment would lead to a better organization of services provided and would save time that can be used for development of new services. If you have to describe a current typical day of a care worker, how do you use ICT for this purpose? I would use ICT for completing the social survey electronically, looking on the web for information to answer to the questions addressed by care recipients. It's pretty difficult to work without immediate access to a digital device or internet. Many care workers must rely on the help of social worker and coordinator centre to help them to answer to the questions addressed by beneficiaries, which is not at all efficient in terms of time. Since we are living in the digital age I hope that the access of digital technologies to be more accessible to care workers in the future than before. Circumstances in which they would use technology would be related to their documentation about the new laws (e.g. the disability law), leaflets for medicines, solutions found by other professionals in the field to similar problems that they are facing. All home carers should know to use a web browser. They should also know which are the application that are installed on an IT equipment and for what can be used this applications, because not all of them have such type of knowledge. Theme 2: Care receivers needs Which are in your opinion the needs of people cared that can be answered by using digital technology? Communication need in the first place because of the lack of a social 220

221 life given the fact that they are living alone for many years. In the every days life of people cared, how can be useful the digital technology? Technology can be a very useful thing for them because through this they would be able to communicate more with loved ones and to open their soul as most of them are difficult people because of the communication lack. Would open for them a door towards social life. Many of them have no TV and are afraid to use modern devices, but if you insist on the benefits that can result of their use, the majority would use them if they will be taught and helped. What types of digital technology can be used by people cared and would require assistance from a care worker? A laptop could be used by elderly with the care worker support. But it should have installed simple applications because they often forget the things that you explained in the previous day. Complex applications where you need to remember many steps would be difficult for them to use. How do you think that people cared will react to the services that are involving digital technology. I think most of them will be pleased. Ladies are more opened to new and I think they would be curious to learn new things offered by technology. It depends very much which is the person that is addressing them, because it must be a reliable person. Surely their whole life will be improved. But more information s about how they will react we will have when we will have the opportunity to offer these services to our care recipients. Theme 3: Digital skills for care workers and caregivers Currently, which are the digital competences that are incorporated into care workers qualifications? From the knowledge that I have in this working sector these skills are not embedded in occupational standards for home care sector. Which are the digital competences that are taught in the actual VET programs in the care sector? Training programs for care workers includes few knowledge of digital technology. These concepts are further mentioned, but the reality is that care workers in these training programs don t have the chance to work and to develop their digital skills. There are non-formal opportunities for carers to develop digital 221

222 skills? Those who passed the age of 50 learn some basic ICT notion from their children, in the family environment. Young care workers have already basic digital skills because they had the chance to work on computers at school or they have this devices at home. Another opportunity is offered through the vocational courses offered by programs financed by the European Union. Unfortunately not all care workers have access to this information and many of them lose the chance to attend these courses which most of them are for free. What skills and digital literacy you consider very important for care workers? Digital skills related to Internet navigation (browsers, search engines) - how and where to find information you need. Digital skills related to text processing and also communication skills using internet instant messaging, Skype, social networking. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: EOS Educating for An Open Society Country: Romania Reporter (+ Cornelia Popescu cornelia.popescu@eos.ro address): Date of interview: 26 September 2012 Place: Maltez Relief Service in Romania Timisoara branch Duration: 31 minutes Name of respondent: Institution / Position: Adriana Cojocaru Theme 1: Current experience with implementing digital skills and ICT in care work Maltez Relief Service in Romania Timisoara branch /social care expert in domiciliary care work sector Field of expertise: Home care Services for elderly, social services; Generally, what do you think about the relationship between digital skills/ict and care? Most of the persons which are part of the domiciliary home care system didn t have contact with the new technologies and there are persons that are in the state of social seclusion. Most of them aren t updated in terms of technologies and digital abilities. Regarding the usage of technology by the elderly, this should be as available as possible by developing special applications taking into account the health problems particular to age with which they are struggling. In your perspective how influenced the advances made in digital technology the care sector? 222

223 Unfortunately, the progress made within the digital sector hasn t influenced a lot the domiciliary care public system in Romania. I couldn t say that it is a connection between the progresses of ICT and the care field due to the fact that the majority of the communication with them is made by phone, face to face communication or letters. Can you tell me some advantages and challenges that digital technology leads in the care area? For many beneficiaries, the advantages will be the fact that they could get in touch with their children, relatives and friends because no one is visiting them and they would love to communicate with them. Regarding the care workers, certain advantages brought by the use of technology could be the bills payment which is their duty or: to look for a certain clinic specialized in certain services, to sell offers of the products that the elderly are interested in acquire. This information can be obtained easily by the help of technology, otherwise they are forced to do some research field in order to find out these answers or to make the payment of the bills. A digital devise can help the carers to find easier recreational and social activities for those that they are taking care of. Of course, this depends also on the elderly s preferences toward what they wish to find out by the help of internet. At present, within the daily activities of home care there aren t comprised activities that include the use of digital technology due to the fact that the majority of the care workers don t know how to use a computer and haven t benefited from training in this field. Just a few of the youngest use the computer on personal level due to the fact that they were interested in developing these abilities. Theme 2: Care receivers needs Which are in your opinion the needs of people cared that can be answered by using digital technology? The needs that can be answered by using digital technology are the need of information and the one of socialization. The technology can keep them updated regarding everything that happens outside their environment because some elderly people never go out of the house being no longer in touch with reality and with what s going on. A better communication with the family is an opportunity that gives them more stability and security. What types of digital technology can be used by people cared and would require assistance from a care worker? Applications by which they can have the possibility of talking to people their own age, by which they can have discussions with common interest. A lot of them are not going daily to day care centres, but maybe from home they would like to interact with people of their own age. Games with themes that attract them example for ladies a game that could allow them to knit online. 223

224 A lot of information regarding the elders: applications and data bases that could help them find out information about the health system, which are the information to which they have to address in order to find out the answer to some of their problems. How do you think that people cared will react to the services that are involving digital technology. Unfortunately we are still at the stage at which we cannot cover the basic needs and that s why is very hard to say how the majority would react to the services that include the use of digital technology. Of course, there are cases of elderly who have used the computer before their retirement and who would like to use one in the future if they had one at home. There are many categories of elderly and they can be differentiated according to their life standard and the health problems they are fighting with. I think that the active ones would like to use technology, it s more difficult with the ones bed ridden. Theme 3: Digital skills for care workers and caregivers Currently, which are the digital competences that are incorporated into care workers qualifications? I don t know if these competencies are integrated in the care workers competencies. I have never studied carefully a descriptive supplement of their competencies, but as far as I know they don t exist. The suppliers for training that develop courses for care workers probably don t consider theses competencies as being important for them, reason for which they haven t been integrated so far in the curriculum dedicated to home care. An analysis of the need both of the care workers and the suppliers of training, and of the elderly must be done in order to see on what level the need of using digital technology is located. Which are the digital competences that are taught in the actual VET programs in the care sector? I have never taken part in such a course and I don t know at present which they are/if the digital competencies are included in the VET programs of the home care field. There are non-formal opportunities for care workers to develop digital skills? The youngest up to 45 years old learn by themselves and have access to the new technologies as all of them have acquired personal IT equipments. There just have to be open-mindedness and interest. The young people entering on the work market are interested in personal development and wish to participate in as many courses of professional training as possible due to the fact that the request at the labor market are higher and higher. It s tougher for those over 50 years old because they never had the opportunity to access technology and they are reserved most of the times. 224

225 What skills and digital literacy you consider very important for care workers? First of all basic knowledge regarding the opening of a computer up to the use of the internet in order to access certain websites for information, to write a document, to connect on a platform and to create an account. Programs like Excel are a little bit complicated, but maybe just on a minimal basis level. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: UbiQuiet Country: France Reporter (+ dguenaux@ubiquiet.com address): Date of interview: 12/10/2012 Place: Le Mans Duration: 2h Name of respondent: Institution / Position: Dominique Guénaux Field of expertise: Theme 1: Current experience with implementing digital skills and ICT in care work 1a) In general, what do you think about the relationship between digital skills/ict and care work? Expert: the relationship with ICT is not natural since the care worker is mainly focused on human and social relationships. For this reason, ICT might be considered as a parasite in the relationships between a care worker and an old person. However, ICT should be appreciated as a tool giving help or assistance to the care worker in the delivery of his or her services. Care workers are challenged and driven by quality of their delivery. Part of this quality, the daily organisation respect of timeline, duration, reporting is a key factor. In this field ICT demonstrates every day how it helps how daily organisation can be improved. How have ICT developments influenced the field of care work? Expert: Nowadays, ICT is everywhere. Smartphones give immediate access to personal information, news, even TV show! The development of ICT in the field of care work has been slower than in some other fields (finance or automotive for instance). However, the large adoption of mobile telephony has had an impact in the organisation of care work. Warning an old person for a late arrival due to road traffic has become ordinary. Can you think of specific advantages and challenges that ICT poses to the field of care work? Expert: On the side of advantages, I see : - better organisation for daily work, - better information for the care receiver, - traceability of care work, - ease of reporting, - report shareability and diffusion. 225

226 On the side of challenges, I see attention to information data privacy, ICT dependance whith problem when ICT is out of order, reliability and robustness." 1b) If you were to describe today s care worker s typical day, how would the use of ICT occur in it? Expert : today a care worker does not use so much ICT in its typical day, mainly due to lack of digital literacy and lack of financial resources. At maximum, will the care worker use ICT through its smartphone to manage contacts, phone colleagues or managers. How relevant is digital literacy for today s care workers and caregivers? Expert : Digital literacy is wide enough for people having time, money, interest and initial competencies to dig into ICT usages. However it requires an initial level of competencies that we barely find in the population of care worker. It sounds to me a real constraint for a large ICT adoption. In your experience, what are the typical circumstances under which today s care workers approach digital technology? Expert: I see two circumstances : - to communicate with others through mobile telephone, - to report beginning and ending of the care work. Theme 2: Care receivers needs Can you tell me more about typical tasks and procedures in a care worker s day that require digital literacy? Expert : the ability to make a quick report for every care work that has to be : -understandable, shareable to appropriate person, useful for recipients, It seems that to make this possible requires a good level of literacy. Some other procedures might require digital literacy. For instances the ability to get constantly informed with new regulations, to share information with colleagues, access to social networks 2a) What, in your opinion, are the care receivers needs that could be met using digital technology? Expert : "Digital technology can help care receivers in two major fields : security and social bonds (communication). In terms of security, ICT can provide means to detect falls or abnormal situations such as lack of nourishing, extreme heat or cold period. ICT can also provide with solution to detect intrusion inside home. In terms of social bonds, ICT can give a solution to limit loneliness, social exclusion, psychological distress, depression. Using ICT might facilitate exchanges to and from others (family, friends, local associations, ). ICT tools can contribute as well to give information about oneself (social network) or to receive local information from outside (mayor or neighbourhood services, local associations, etc...). In care receivers daily lives, how could digital technology be of help? Expert : "I already answered that question." Which kinds of digital technology could be used by care receivers themselves, and which would require a care worker s assistance? Expert : "Four basic digital technologies could be used by the care receivers themselves : Television, computer, smartphones, smart objects. Television does not require care worker's assistance as long as the care receiver can still use the remote control. New connected televisions can provide with information from the internet. However if care worker's assistance is not necessarily required as a daily use, it is likely that care workers will configure TV services and application to download in the place 226

227 of the care receiver. Computer is obviously the ICT tool per nature. However the complexity is likely a constraint for a normal usage for a care receiver. Smartphones or tablets are good ICT tools. They mainly erase the complexity of computer. But they induce other constraints associated with sensorial deficiencies such as bad vision, hand shaking. In these cases, size of screen and touch screens might be a real issue for this population. Smart objects can take several forms. Some of them are well indicated for people with bad vision and poor ICT literacy. In this case smart objects are mainly focused on usage simplicity and communication. However certain functions accessible from computers or smartphones are not usable." 2b) How do you think care receivers will react to services involving digital technology? Experts: the reaction will be related to different basic aspects : the place inside home that will be given to the digital technology. Here we find design-for-all attributes where aesthetics will play a major role The ease of usage, the simplicity The ease of connection to the internet the first impression to be capable of using the digital technology. If perceived to complex at first sight, it will be difficult to change of mind." Can you describe your experience with care receivers acceptance of ICT- based services and activities? Expert : The usage has to be demonstrated first. At first, care receivers won't perceive the benefit of digital technology so the acceptance will be really difficult. Once you have demonstrated the benefit and simplicity of usage you will get a first level of acceptance. But the real acceptance of digital technology will effective once the care receiver will have used it by its own. Theme 3: Digital skills for care workers and caregivers 3a) Presently, how are digital skills incorporated in care workers qualifications? Expert : I have no information about care workers' qualifications. Are there any non- formal possibilities for care workers to enhance their digital skills? Expert : I think we can indeed help care workers to enhance their digital skills. Two paths might explored to enhance through: games situations where care worker might be positively rewarded. For instance helping the care receiver who is more demanding than himself or herself to get access to digital technology. Situations where care worker meets pairs (other care worker)." 3b) Which digital skills and competences would you name as substantial for care workers? Expert : - understand technical terms (from basic to intermediate) - competences related to install at home devices for internet access. How to connect an adsl box for instance a certain ease to call technical support in case of problems use an internet navigator. 227

228 3c) Which additional digital skills and competences would you regard advantageous for care workers? Expert:"For digital skills ther are: , applications, files manipulation, installation of new applications. For the competences : curiosity, i think they have no fear to make something bad." What else might a care worker know, understand, and be able to do in addition to substantial ICT skills? Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: IFEF Country: France Reporter (+ Cathy Legendre cathy.legendre@iperia.eu address): Date of interview: 12/10/2012 Place: Paris Duration: 1h30 Name of respondent: Franck ROUGEAU Institution / Position: Founder & President of SPARKOM Field of expertise: Social Support & Social Learning Theme 1: Current experience with implementing digital skills and ICT in care work 1a) In general, what do you think about the relationship between digital skills/ict and care work? Digital skill is not only about equipment and software but also about how to use them, how to be familiar with them so that their usages become part of your life, part of your work. Training can take different forms and a recent academic research has shown that the classical lecture or group work drives a skill retention factor of 5 to 35%, the simulation (video, game) 60 to 75% and the guided practice up to 90%. In your experience, what are the typical circumstances under which today s care workers approach digital technology? This is the latest that we have tried to implement among care workers so that they quickly reach the skill level that will turn the ICT into a natural productive tool for them. Practically, the solution was to implement a social learning platform so that, in addition to formal learning sessions, the care workers, being organized by competencies, could help and guide each other remotely on demand using synchronized communication services such as chat, screen sharing, VoIP, remote access. 228

229 Theme 2: Care receivers needs 2a) What, in your opinion, are the care receivers needs that could be met using digital technology? The care receivers may have narrower usages of ICT than care workers but are as well confronted to the same paradigm how to do, how to use. There are several product lines that have been developed to address that specific market. They intend to simplify the interface to ease the appropriation or to adapt to an existing media device at home. All these innovations certainly benefit the care receivers; however, huge diversity of skill levels in that population requires a whole panel of solutions. Some would appreciate extremely simplified devices with basic functions while some other would not accept anything else than a standard PC to avoid the stigmatization of senior devices. Theme 3: Digital skills for care workers and caregivers 2b) How do you think care receivers will react to services involving digital technology? Whatever the equipment, the problem remains the same; how to be supported in its usage. The diversity of solutions and abilities being extremely important in the care receivers population, there are no other options than the crowd support to cover all demands. So, apart from appropriate equipment and software that should be individually assessed taking into account each care receiver s capabilities, the next big thing is to organize communities of co-ictusers among the various segments of care receiver s population and to organize a platform so that the help between peers is made easy, quick, efficient and available. 3a) Presently, how are digital skills incorporated in care workers qualifications? It is utopic to consider that the care workers shall have all Digital skills that the care receiver might need. However, apart from the ability to properly use the specific ERP chosen by their organization, the care workers and care givers shall have a minimum digital literacy in order to know how to behave in front of a specific request. 3b) Which digital skills and competences would you name as substantial for care workers? First of all, they must all have a general understanding of how a general digital hardware works (power supply, connexions, switch, cables, wifi, ). Secondly, for some generic products they should know the basic manipulation to make them work. Tablets : switch on, flip page, clic on icons, web browse, appstore, create Computers : switch on, clic on icons, web browse, create Smartphone : switch on, clic on icons, appstore TV : switch on, scan channels, select Thirdly, they should be capable to contact any device support desk (contact channels being supposed to be at care receivers premises. If not they should be capable to investigate with care receiver the appropriate support desk) and be able to describe the problem and eventually to execute the instructions from the support desk to solve the issue or to organize a support visit. Comments, any other information: 229

230 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: IFEF Country: France Reporter (+ Cathy Legendre address): Date of interview: Place: France Duration: 1h Name of respondent: Christian Schoen Institution / Position: Field of expertise: Web communication Care sector Theme 1: Current experience with implementing digital skills and ICT in care work Generally speaking, what do you think about the relationship between digital skills/ict and care work? Additional questions - In your opinion, how have developments in digital technology influenced home care and assisted living services? According to you, do information and communication technologies offer specific benefits and challenges in the field of home care and assisted living? I would say that there are essentially two obstacles: - The digital divide: Many people have a negative outlook on ICTs and it is a problem of training and information about the benefits of ICTs. The use and spread of ICTs should be encouraged as these practices tend to improve professional communication with employers but also between professional peers, i.e. the professionalisation of home care and assisted living services. - The technological developments -which seek to meet expectations and needs unlike ICTs which do not seek to get people accustomed to them (e.g. touch screen vs. spreadsheet programmes). With voice recognition technology, we will be able to dictate things to tools (iphone). Nobody will then say that they're too old for that. The next revolution is the disappearance of the keyboard; we'll be able to speak or give one's computer back. Also, everything related to mobility, as we are 24/7 available and connected to people. For professionals, it will mean being able to access these data. We will be able to network and share info but also be contacted by customers round the clock. If you had to describe the home care and assisted living daily routine for an elderly person, where would the use of ICTs fit in? Additional questions - According to you, in what way is digital literacy relevant for home care and assisted living workers nowadays? - According to your experience, in which circumstances do home care and assisted living workers approach ICTs nowadays? Can you tell me more about these workers' typical daily tasks and procedures which require or may require digital literacy? There are three main areas: -Orientation: let's say current team facilitator. ICTs must facilitate the work that a person currently does. Housework will always just be housework but cooking means having access to recipes. It can allow people using the media to get support, in the same way as with e-learning. -The whole relationship between three legal persons: the elderly 230

231 person and the helpers (information according to profiles and interprofessional relationship, shared medical and social records). -Last area: the administrative sphere to help professionals to manage their time (geolocation, duration etc.). A number of regional and local authorities strongly insist on this aspect as it allows to make significant savings. In fact we say -and I don't have all the precise figures- that between 20 and 25 % of the services provided are not quality ones or they are not delivered at all. However, as soon as we have a social record to know what has been done or not, we are able to act adequately. Question about digital literacy I don't see how anyone in the world can avoid -at least for a long timeusing ICTs at work. Drawing from this, it seems obvious that supervisory bodies, supervisors, and institutions must make sure the benefits are clearly understood. In Nordic countries, we see the same problems with elderly people: the penetration rate of ICTs is 80-90%. Supply needs to meet demand and it has to put people at the centre so as to provide them with the solutions they request. It has to help them to understand (it's a matter of sensitising and training them) that these tools are there to help them and not to watch or spy on them. When we talk about professionals, it varies. They essentially address them on a professional and administrative level. No professional today uses Internet or Extranet systems to be in contact with institutions. When it is more difficult is when ICTs are used in the relationship between the professional and the elderly person or his/her relatives, especially when the elderly person doesn't know ICTs or is afraid of them. People always wonder what purpose they serve. Technology's lack of humanity or image is a problem in the relationship. In my opinion, what is essential is the issue of good practices. It is key in the professionalism and optimisation of the services provided...in all these fields. It goes with the demand which will continue to increase due to the ageing of the population, the social security deficit... I don't think there will be more care and services paid for by society. Also, with desertification, there are places where there is no doctor. Telemedicine could make things easier. It would provide professionals with the necessary information media to have access to data (which requires raising awareness, informing and teaching people). Northern Europe is investing a lot in the e-health industry, which is one of the solutions. It means sharing skills on a daily basis at the same level, same profile, with the same demand to professionals. Supervisors must be present in this circuit. Human contact is indispensable but many things can be dealt with through ICTs. Twenty years ago did all executives have a secretary? Now they do everything their assistant used to do. ICTs have brought about developments in the professional world. 231

232 Theme 2: Care receivers needs - In your opinion, which of the home care and assisted living recipients' needs could be satisfied through ICTs? Additional questions: - According to you, how can ITCs help home care and assisted living recipients in their daily lives? - According to you, what types of digital technology could be used by the care recipients themselves, and which ones would require the assistance of a home care worker? I'm not going to say yes or no. Everything that doesn't require a specifically human or even physical intervention. ICTs must analyse this to see whether they can do or help to do some things. For sure, some require human presence or physical actions. They can't be substituted. Physical actions cannot be replaced. We will for example work on teleauscultation. It allows doctors to make sure that kinesiotherapy for a bronchiolitis-affected child has been performed well. Highly medical acts can evolve. It's the other benefit for technologies and patients, as we can see. There are two aspects. We may have expectations and needs at certain times that don't correspond to the professional visit times. I'll draw a parallel with the number of people that go onto the Internet before and after a medical consultation. I think it's the same thing with home care. People want to be in the know and they don't understand the care they are being provided with. They are unable to say what's going on around them. It's difficult to inform all their relatives about what has been performed, what should or shouldn't be done, so when I think about the development of ICTs I see a possibility of answering people's request of being provided with a service. Another aspect that will be enhanced We tend to essentially talk about medical aspects. However it is important to note that most elderly people are affected by at least one chronic disease. When they reach a certain age, they have several chronic diseases but with current existing medication, most of them are well treated and lead a normal life. The fact that people live longer without disabilities goes to prove it. The age of entry into residential care homes is increasingly higher. On the other hand, elderly people will expect more in terms of social and healthcare services, supplementary things as opposed to mere medical services, I mean for diseases and treatments. - According to you, what types of digital technology could be used by the care recipients themselves, and which ones would require the assistance of a home care worker? In any case and for quite a while anyway, workers will have to explain the benefits that technologies will bring to the recipients, for when they're not around. I have worked a lot on training and raising awareness among GPs about the Internet. When they have overlooked using it, they have missed a supply of information and advice that they have absolutely no clue about. Health professionals must adopt the tools created for their clients and get these same clients acquainted with them. - How do you think home care and assisted living recipients will react to these services involving digital technology? Additional questions: - Drawing from your experience with home care and assisted living recipients, can you explain to us to which extent they're ready to accept ICTbased services and activities? In this particular situation, what are the advantages and the drawbacks? 232

233 Two things. I think that if technologies are well presented, people will see all the benefits. They will also see all the drawbacks but they will see more advantages than drawbacks. A ground swell is underway. There is an increasing number of elderly people, there's the social security deficit...they're going to understand that ICTs may be an answer. Useful and indispensable tools: Look at the number of hits on sites like Doctossimo, sites whose creation was suggested by patients or to deal with a particular disease, blogs or forums. I think that if there is no control from authorities or professionals we'll see significant excesses. That's what access to information is. And the second is time management with calendars; all these tools that enable you to share information, social networks, and networks developed by health staff that are adapted to elderly people. Advantages: Permanently and readily available services. Internet runs 24/7. If the service is well designed, it will enable elderly people to get in touch. Drawbacks: dehumanisation and data ownership. We're lucky in France to have a well developed CNIL (French supervisory authority) but there is some data leakage beyond the CNIL's control. Theme 3: Digital skills for care workers and caregivers - How many digital skills are included in the qualifications framework of home care and assisted living workers today? Additional questions: - Which digital skills are taught today in vocational training programmes in the field of home care and assisted living? - Are there any possibilities for home care workers to improve their digital skills? I'd tend to say very few. I think that administrative aspects, relationships between employers and employees or the supervisory team are well addressed. Something else... I'm talking about everything you do at Iperia, with all the training and educational part which is quite well developed. Concerning the service and care provided, we receive significant training. When we are in front of a home care worker who has no digital skills or has a negative attitude towards ICT, it can be stigmatising to admit that he/she doesn't use technology. It can be a problem... We shouldn't teach him/her IT skills but provide him/her with solutions to his/her needs. I'm talking about "HOLD'UP, an organisation that teaches ICTs to the elderly. We ask them: "what do you want to do?" If they answer that they would like to share pictures with their children, we'll help them to share pictures. Once they have understood the benefit of technology, debunked the myths, they'll ask for something else. If there is no change in the users' behaviour in the field of home care, we're heading for disaster. If we force someone to do something, that'll lead nowhere. They'll always do things reluctantly. I'm convinced of that. If we don't focus on what people need, and we look to impose our solutions, then it just won't work. E.g. remote alarm systems whose penetration rate is low and that we impose on elderly people whereas THEY are not the clients. It's the relatives who impose them for safety reasons. - Which other digital skills and abilities do you regard as interesting for home care and assisted living workers? Additional questions: - According to you, what other aspects in addition to ICT skills should a 233

234 worker in this sector know, understand and be able to do? They must be taught how to use the ICTs they need. That's all. We shouldn't strive to teach them global capabilities. They have to acquire what I would call "new skills" to extend the skills that they already have, especially regarding advice, information, follow-ups, in lasting relationships. Understand and use what they need professionally speaking and professionalisation, i.e. positive developments in their job and career paths. Understand and use what is useful to their client. They have evolving demands and needs and you have to satisfy them. I'm talking about relationships in the broader sense, keeping in touch to ensure the provision of services. Professionals focus on the medical aspect. Yet health and social needs are developing: how to exercise, how to eat... I'm thinking about an application which allows to recruit disabled people from a distance thanks to a videoconferencing system. I find this approach interesting as it allows to cover many issues and to think about potential developments in the sector. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): FEPEM FRANCE Céline BEDEL cbedel@fepem.fr Date of interview: 28 SEPTEMBER 2012 Place: Duration: Name of respondent: Catherine OLLIVET LE RAINCY 50 MINUTES Institution / Position: - President of France Alzheimer for the Seine-Saint- Denis - Member of the medicosocial board of the ARS (Agence Régionale de la Santé) Ile-de-France - Coordinator of the Espace national d éthique Alzheimer - Administrator of France Alzheimer at the national level - Member of the ethics committee of the Société française des technologies pour l autonomie et Field of expertise: ALZHEIMER S 234

235 de gérontechnologie (SFTAG). Theme 1: Current experience with implementing digital skills and ICT in care work Theme 2: Care receivers needs It is important that careworkers acquire ICT skills because it can help them to access new knowledge about their work and about their environment (through the use of the internet, for example), as well as to build a real career path. On a practical level, digital skills can help to better manage the activities of careworkers, through exchanges with employers (whether private employers or organizations who act as brokers), transmission of work schedules or pay slips, and access to new information, that will empower careworkers, for example, to choose a training programme and gain access to it. In addition, digital skills can help the careworkers to overcome various obstacles, such as the linguistic barriers faced by those of foreign descent who are not fluent in the language of the care receiver, and/or who do not have a good command of the written language. ICT can, in some cases, act as a useful tool: careworkers sometimes prefer texting because spelling matters less in that kind of communication. For people losing their autonomy, the mastery of digital tools can help break their isolation by enabling them to interact with their surroundings more easily (communication with their family, watching TV programmes again, etc.). In this context, careworkers can facilitate the link between the assisted person and his/her environment. Their intervention is often the only way people losing their autonomy can communicate with their environment. But these people tend to be very reluctant to engage with new technologies and it is essential that they be well informed. In retirement homes, the reticence towards computers of those who are losing their autonomy can be assuaged by a facilitator (assistant). The stake of mastering ICT is even higher for the careworkers when the loss of autonomy is more severe. People suffering from Alzheimer's can wander off because they have lost a sense of time. Digital devices already exist to deal with this: bracelets, fridge sensors (to check if the person has eaten during the day), fall detectors. These tools are fairly autonomous since they are operated by companies who specialize in remote support. But they nonetheless require the intervention of the careworker, if only to start the device or maintain it (by charging the battery, cleaning the device, checking that it works). 235

236 Theme 3: Digital skills for careworkers and caregivers In the current training programmes for careworkers in France, ICT skills are not foregrounded. The administrators of the broker organizations, which act as intermediaries between those losing their autonomy and those whom they employ, for purposes of recruitment, or writing up pay slips, can hope that careworkers master these skills, so that the working relationship can be managed more easily (by sending pay slips by , for example), but even if they are desirable, ICT skills are not compulsory. Regardless of the type of training, in the field, we meet careworkers who want to receive training. They legally have a right to be trained, and programmes do exist. But in reality, it is very difficult to arrange for these workers to attend training courses because they must obtain the agreement of all their employers, and they often have several when they work without intermediaries and are paid directly by the care receivers. When these careworkers leave to attend training sessions, they are not replaced. For those who are losing their autonomy, and need daily assistance, the careworker s absence can be difficult to deal with. In this context, digital technologies can become a tool for distance learning: one can imagine careworkers participating in training programs from a distance, through a screen, during working hours, from the home of the person they are helping. Regarding the training itself, the teaching of ICT skills must rely primarily on simple guidelines and be combined with the teaching of French, in order to help workers process the new skills better. The training must also ensure that basic computer skills are mastered (checking connections, updating tools, etc.). One must not forget, of course, the issue of the privacy of the person losing his/her autonomy: the ethical dimension, the ethics of the individual, must be an integral part of the training courses, because access to digital tools opens the door to potentially harmful conduct (for instance, using pin numbers, etc.). Because care receivers are vulnerable, ethics must play a crucial part in the training of careworkers, which must stress the need for a heightened professional conscientiousness when dealing with a vulnerable population. Comments, any other information: 236

237 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): FEPEM France Celine BEDEL Date of interview: Place: Duration: Name of respondent: Docteur MBOKO Theme 1: Current experience with implementing digital skills and ICT in care work France 1h Institution / Position: Local Council of the Sarthe; Public Heath doctor, in charge of the CLIC (Centre Local d Information et de Coordination) for the département of the Sarthe. Field of expertise: Monitoring the coordination between careworkers; assessing the APA (Allocation Personnalisée d Autonomie), a benefit aimed at promoting autonomy Testing of innovative solutions in the homes of the elderly ICT are a benefit to the jobs of careworkers and the autonomy of dependent people. Careworkers will be more and more encouraged to use technology professionally, which will transform their job while also raising its profile. Because careworkers are physically close to the dependent people they are helping, their role must be fully recognised along with those of other professionals who monitor the health of the care receivers. Their mastery of digital tools will encourage this. By using a digital reporting notebook (or ), careworkers can relay up-to-date information on the health of the care receivers (by monitoring their general condition, automatically checking their blood pressure, etc.) to other careworkers and health specialists (doctors, visiting nurses) and to the family. Careworkers need to master basic digital skills in order to do this, such as the ability to use , touchscreen tablets and USB keys. The département of the Alsace is currently conducting an experiment in telemedicine. The evaluation stage that will record the reactions of careworkers faced with new practices has not yet begun. New technologies can also help managers (who work for the organisations acting as service providers or brokers) to organise the working hours of careworkers, by allowing them to report their working hours online. The human bond between the careworker and the care receiver can be enriched by the time they spend together using the digital tools surrounding 237

238 the care receiver. Theme 2: Care receivers needs Among the needs of dependent care receivers that can be fulfilled by new technologies are social contact and safety. Dependency has an isolating effect. The use of new means of communications (webcam, web platform??) can diminish the solitude of the care receivers and enhance their well-being. Safety in the home is a major concern for dependent people, as they risk falling, losing their sense of time and space or wandering off. Yet, a series of conditions must be fulfilled, in order for the elderly to accept technology: it must be seamless, costless and mastered by their caregivers and careworkers. Disabled people and the elderly have different needs, the former more technological, the latter generally thought to be more human. New technologies seem more suited to the needs of the disabled (technical equipment, automation of gestures and home automation, etc.) Theme 3: Digital skills for care workers and caregivers Digital skills are currently not included in professional training programmes even though the usefulness of technological tools is now evident. In the countryside, for example, where distances are greater, digital tools can facilitate the work of careworkers by enabling them to share information, develop prevention and report their work promptly. Regarding the learning process, digital skills must be studied within a more global framework, in order to help careworkers to see general patterns, as well as to develop their intuition and their curiosity. Locally, cooperation between Regional Councils (in charge of training programmes) and Departmental Councils (in charge of dependency) would ensure that the technological needs of dependent people are taken into account when training programmes are created. Comments, any other information: 238

239 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): FEPEM France Céline BEDEL Date of interview: Place: Duration: Name of respondent: Sophie GRAVIOU France 1 h Institution / Position: Quality manager (in charge of, among other things, the communication and development of projects dedicated to testing innovative solutions to help care receivers stay in their homes) for the non-profit organisation ASSIA (Association de Soins, de Services et d Innovation pour l Autonomie), part of the UNA network (Union nationale de l Aide, des Soins et des Services aux Domiciles). Field of expertise: Services in the home Testing of innovative solutions to promote autonomy Theme 1: Current experience with implementing digital skills and ICT in care work What is the added value of ICT skills for careworkers employed in the home? Two distinct set of ICT skills must be considered: - Skills that can improve the working conditions of the careworkers (and the management of their work), by enabling them to report their hours of work and/or to send information through a Smartphone, or to use a digital notebook (that can be accessed and filled in remotely, and is also accessible to the care receiver s family.) - Skills that pertain to the care of the care receivers and the development of their autonomy, such as their managing entry codes to access the home and their mastering the use of the internet, in order to encourage care receivers to shop online and to free up time for the careworkers. Contemporary technologies such as phones and the internet are sufficient to improve the management of care work: they save time, allow careworkers to coordinate with each other, and improve the safety of care receivers. Other tools such as digital reporting notebooks accessed via tablets could be very beneficial, to ensure a proper follow up, to obtain and 239

240 exchange information at a distance, and to improve the coordination of careworkers and care givers. Theme 2: Care receivers needs The primary need of the elderly remains human contact. - The use of ICT must be associated with togetherness and conviviality. Digital technologies can help fulfil this need, for example through Wii games or Skype sessions in the presence of relatives or careworkers. - Another important aspect is the usefulness of these technologies. The acquisition of digital skills by dependent people must be triggered by a clear demonstration of how their autonomy would benefit from them. Technology must be rendered seamless, so that the habits of the care receivers remain unchanged (for example when a double system of keys is implemented, with traditional keys for the care receiver and digital entry codes for the careworkers.) Technology cannot be a substitute for human contact, but must be part of a wider range of services aimed at catering to the needs of the elderly. It is crucial to assess situations correctly, in order to prevent the destruction of extant human relationships. The cost of technology is also a dissuasive factor for dependent care receivers. Who pays for it? The issues of cost and usefulness must be addressed if they are to engage actively with digital tools. Theme 3: Digital skills for care workers and caregivers The development of ICT skills is not included in training programmes for careworkers. Several factors have a restrictive effect: - The cost of equipment (who pays for the internet subscription, for example?); - Legal issues about the transfer and sharing of data (can a careworker use the computer of the care receiver?); - The creation from scratch of ICT training courses for careworkers; - Ethical issues, in order to regulate access to the care receiver s privacy. Today, the main goal is to demystify technology by convincing careworkers of its usefulness. Careworkers fear that their work will become dehumanised and are afraid of change and excessive monitoring. In order to engage with and relate to these new technologies, they must have the opportunity to test them (in showrooms for example). The potential uses of digital devices become more evident when they are apprehended through the senses, when they can be handled and seen. Careworkers need all existing ICT tools to be provided with an appropriate and official certificate. 240

241 Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): FEPEM France Date of interview: Place: Duration: Name of respondent: Marjorie Bied Isabelle PUECH France 2h Institution / Position: Orange Labs : social science and economics laboratory SENSE (Sociology and Economics of Networks and Services) Field of expertise: Sociologist in the medical and social field. Master s thesis reviewed experiments with touchscreen tablets (cf. her article published in Management et avenir, co-written with Jean-Luc Metzger (2011): «Comment les logiques de rationalisation du secteur médicosocial peuvent-elles soutenir les pratiques collectives des professionnels?», Management & Avenir, 41). PhD in sociology on the achievements of caregiving in the home ; analysis of various types of caregiving through the lens of digital solutions, using as a basis the practices of managers of caregiving agencies and of homecare workers 241

242 Theme 1: Current experience with implementing digital skills and ICT in care work Review of a first experiment (April 2009-September 2009) Context: a call for bids launched by the Conseil général of the Centre region, and which the company applied for with very little notice. Object: an A4 touchscreen tablet in the home of elderly care receivers, designed for three types of users: the care receiver, the caregiver and the family. The touchscreen tablet already existed; it was being tested in a lab but wasn t used in the homes of care receivers. The marketing department of the company didn t know what content to develop. They based their work on a series of ideas, without analysing precisely the needs of the elderly or the practices of the caregivers. Why? Because they lacked time to develop new solutions and also because the marketing specialists didn t realise that it could be useful to analyse the needs of the various people involved in the home of the care receiver. The touchscreen tablet was made of three parts: - One section was devoted to careworkers; the traditional reporting notebook that careworkers had to fill in at the homes of the elderly care receivers has been included in the tablet. - A second section was intended for the use of the care receivers: a very simplified system enables them to communicate easily. Pictures of contacts (mainly family) have been included in the tablet and preset with the related addresses. The care receiver only had to touch a picture to be able to start typing an to this person. The first obstacle for care receivers at the beginning of the experiment was to find the letters on the keyboard. They could choose between an AZERTY and an alphabetical keyboard. They could also choose to type on a keyboard or to use a stylus. A calendar included in the tablet enabled them to write down their appointments, as they would have done in a diary. - A third part was devoted to the family; they could scan pictures and organise them in various files on the tablet. The picture would be visible when the tablet went to sleep, like on a digital photo frame. This experiment was not a success with the careworkers. Why? - Because their training was insufficient. An ergonomist from the company had explained how the tablets worked to the managers of the participating homecare agencies involved in the experiment, but these managers hadn t themselves trained the careworkers (because the experiment had been imposed by the local council and because the managers who were well disposed lacked time, once they had been trained, to become more familiar and comfortable with the tablets and to properly train the careworkers. The careworkers thus had to take 15 to 20 minutes from their own worktime to discover the tablets. That didn t encourage them to use the devices. - It took the careworkers too much time to use the tablets. It was quicker for them to write by hand than to type on the keyboard (it was therefore suggested that rather than type the various tasks they had 242

243 done, they should just have to tick boxes in a pre-existing table containing a list of all the potential tasks.) - A reticence to share information on the work they had accomplished. The careworkers were afraid that the information entered into the tablet could end up on the internet. It seems that careworkers are reluctant to share information on their work. They don t see the need to share the reporting notebook outside of the home of the care receivers. In their opinion, the notebook has to stay in the home of the care receiver and be used only by the trio made up of the care receiver, the care worker and the caregiver. They agree to talk about their personal experience, but only anonymously, as they do in training sessions, discussion groups or on blogs The careworkers would be less reticent to share technical or practical aspects of their work, discuss skills or general issues such as I have this type of problem with one of my care receivers; have you already faced this type of situation? The experiment was also unsuccessful with caregivers. Why? - They found it difficult to scan pictures (long and burdensome). - Some of them were unfamiliar with computers. The experiment was more successful with the care receivers. Why? - They liked most the messaging service. They didn t use the digital calendar because they preferred a paper diary and didn t have the reflex to fill their schedule on the tablet. - For the first stage, setting up the device in the home of the care receiver, it was sometimes necessary to drill a hole in a wall. This proved to be complicated and required negotiations with the care receivers, who were worried about damage made to their home. - The second stage involved the training of the care receivers by the people who had set up the devices. They had to explain how they worked and monitor the use of the care receivers at the beginning. Once they had overcome the handling of the stylus, all the care receivers were able to use the , and write mainly short messages (similar to text messages) to their families and caregivers. In the end: Despite the success of the simplified system, the experiment was stopped, among other reasons because it had been conceived by marketing specialists, without any analysis of the precise nature of the needs and expectations of the various people involved in the home, and because it wasn t meant to be continued. Review of a second experiment 243

244 Object: a voice-messaging service for people who are beginning to have memory lapses or are at the first stage of Alzheimer s, as well as their caregivers. Family caregivers have a login and an access code that enable them to go on the internet and call the care receivers or leave them a message. In order to do this, the caregiver must have a computer with an internet connection. He/she can record a voice message, choose the frequency of delivery and save it with the phone number of the care receiver. On the appropriate day, the phone of the care receiver will ring. There are three tries, 15 minutes apart. If the care receiver picks up the phone, he/she will hear the recorded message. If he/she understands it, he/she presses a key and hangs up. The caregiver will receive a message confirming delivery if the phone has been picked up. There is one constraint: the message must be recorded the day before delivery. This experiment was unsuccessful. Why? - It was hard to recruit participants. The organisation didn t find anybody to test the technology, despite going through CLIC and CCAS networks. The target was very limited as the project needed to rely on caregivers connected to the internet who cared for people with small memory lapses, aged between 70 and The project initially stemmed from a marketing idea, a purely abstract vision, without any analysis of the daily practices of care receivers and caregivers and without any observation. An experiment disconnected from practices never works, even if the idea is brilliant. - The need to outsource created constant obstacles. Because of outsourcing, some softwares turned out to be incompatible; developers were hard to reach; it was extremely difficult to get all those involved around a table to solve the series of problems (2 months were necessary to gather all people working on the project), and huge delays occurred The lack of centralisation led to a huge waste of time. What are the keys to success? - The new technologies must be incorporated into the original set up. They must build on existing practices. We often see caregivers inventing new solutions, noting down on paper new ideas, on post-its for example. New technological solutions must build on what the caregivers themselves invent, locally, before envisaging how it could be spread. It is necessary to work from existing habits to conceive and spread solutions that work and are used. - One must find the appropriate language and translation. Caregivers must be able to explain their work and their constraints to the 244

245 Theme 2: Care receivers needs Theme 3: Digital skills for careworkers and caregivers designers and developers, which means that they must be able to identify certain things, problems, emotions and phrase them in a language that is understandable by outsiders. The designers and developers must then translate these practices into a technical form, and foresee possible transformations as all devices will require adjustments. The design of a new system requires a constant exchange on what works and what doesn t; it is a co-design. This requires time and adjustments, whereas the solutions experimented are often based on a marketing idea that doesn t work and that is immediately abandoned. - The careworkers need some help to articulate the nature of their work. This can be achieved by organising group sessions during which they can share their work experience and develop a reflective vision of their job. - The various people involved in the home must be consulted before the project is launched. In the calls for bids, for example, the specifications must include times set aside for collective discussions. - It is necessary to assess how professional practices are changing with the development of new technologies (that are transforming these jobs) and to adapt new systems to the reality of the home and of the care receiver. - The new technologies that are implemented must be simple, easily accessible and must avoid stigmatising the care receivers (for example phones or calculators with very large keys can create a stigma!). - New solutions must take into account a specificity of care giving: the careworkers professional mobility as they often move from one home to another. They must be able to access information and communicate remotely. They are a lot less likely to use a computer than a mobile phone or a smartphone. - The care receivers must be able to communicate with their families without disturbing them (they often worry about disturbing others), through a simplified messaging system that can be less intrusive than the phone. They must be able to know what is going on around them, especially in their neighbourhood or even in their building. Experimental collaborative platforms within buildings have already been put in place with social agencies (cf. Bien vieillir au domicile, by Carole- Anne Rivière and Amandine Bruguière/Fondation internet nouvelle génération). The main need that was identified is the need to communicate with the family and close neighbours. In order to develop these types of skills, it is necessary to organise group sessions during which the participants learn to formulate and articulate the nature of their work. It is also important to build on the existing practices of the careworkers. 245

246 Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): FEPEM France Date of interview: Place: Duration: Name of respondent: Marie-Béatrice Levaux Isabelle PUECH France 1h Institution / Position: President of the FEPEM (Fédération nationale des particuliers employeurs de France) Member of the Conseil économique, social et environnemental Employment and Work section Founder of the IPERIA Institute Field of expertise: Jobs in the home; social issues relating to homecare, especially for people who are losing their autonomy; professionalisation of jobs in the home. Theme 1: Current experience with implementing digital skills and ICT in care work Inclusion is what is at stake in the debate about the ICT skills of careworkers and caregivers. Europe has a much more positive attitude towards this issue than France, and casts it in terms of a digital inclusion rather than a digital gap. Digital inclusion has many similarities with the logics of social inclusion. Contemporary public policies all include a move to paperless environments (such as e-administration), which all citizens must be able to negotiate. In the field of homecare for people losing their autonomy, careworkers have few qualifications. Their schooling has rarely made them familiar with digital tools. And they can t afford to use digital devices such as tablets that are becoming increasingly popular. But today, the professional and social integration of our fellow citizens relies on a better understanding of the uses of ICT. It is a major professional stake since there are very few jobs left that do not require some ICT skills. It is necessary to acquire these ICT skills to understand how the digital environment in the home is completely changing. Communication tools are increasingly used between the various professionals who work in the home and among these, careworkers mustn t be excluded since they are the one constant link in the daily life of the elderly: a physiotherapist may visit for half an hour, a nurse may come in the morning, a doctor once a week, but 246

247 Theme 2: Care receivers needs overall, it is the careworker who is the most permanent presence in the home of the person who is losing his/her autonomy. If careworkers are trained to acquire better digital skills, the profile of their job is raised. By considering that ICT skills are a necessary requirement for this kind of work, we assert that it is a real profession and not simply an aggregate of household tasks, traditionally devolved to unskilled women. By developing the ICT skills of these careworkers, we define their work as one that relies on a range of versatile activities, most suited to help with providing a better experience for someone living at home. Practically, ICT can help the careworkers and caregivers in their daily work by enabling them to exchange information, instructions and messages with the other workers involved in the home. All of them can thus become truly complementary partners in the care of the person losing his/her autonomy. The use of ICT must be understood at several levels. First of all, there is the implicit, natural and unknowing use of ICT by care receivers, helping them to break their isolation, to create social bonds, to cultivate family bonds (via the internet, digital photo frames, etc.). In those cases, the elderly are making use of digital tools, but without engaging with their technological complexity. All of these help them to avoid loneliness, keep a connection to the outside world, and allow information to come into the home, about the life of the neighbourhood, bus timetables, their family, grandchildren, etc. Many elderly people already make use of technology in this way, without necessarily being aware of it. Another important issue is security and prevention. A few years ago, the elderly could only rely on a telephone beeper to alert their relations or neighbours. Today, the natural and logical development of this first stage is the creation of a safe home environment for the elderly so that they can live alone without round the clock physical help. In order to achieve this, they must become much more familiar with ICT and home automation. But this also raises the issue of an intrusion into their privacy: how can the privacy of the care receiver be preserved while assessing and preventing risks in the home, notably risks of falling? Many elderly have to go to hospital because of a fall. And this often leads to a rapid worsening of their health and a loss of autonomy. It is also an important cause of death. To prevent the elderly from falling in their homes, we can use a variety of tools, of alerts (for example luminous paths and laser devices) in order to build a safe environment around the elderly or isolated care receivers, that must be explained by professionals. If these devices are used without being assessed or explained by careworkers, they will remain intrusive gadgets, unsuited to the goal of preserving the intimacy and private life of people. Developing the use of ICT is also a way of setting up a means of fast communication, for example for when there is a risk of pandemic. A few years ago, when France was on high alert for flu epidemics, the information campaigns that were launched in response to the H1N1 virus had a lot of 247

248 difficulty targeting home careworkers. Public authorities informed and worked systematically with health workers Yet they never engaged with domestic careworkers who move from one home to another daily, carrying very high risks of contagion. Theme 3: Digital skills for care workers and caregivers Digital practices already exist: the use of the mobile phone, the internet, social networks (Facebook, twitter...). We need to outline digital practices that can become part of professional skills. When the IPERIA Institute opened its distance learning training (FOAD) to careworkers, we realized that what was holding them back wasn't that they would have to use a computer alone to complete their training but rather the idea that they had to go back to school. The FOAD gives them a certain freedom in relation to the time they need to absorb new information. They don't face the judgement of others; they are not totally isolated since they are given online tutorials. And they can also participate in this kind of training programme in small groups, locally. Training must become a way of breaking professional isolation and creating a professional network. Digital practices must become part of existing training courses, and careworkers must be made aware of these issues, in order to acquire progressively the right reflexes and not be afraid of ICT. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): FEPEM France Date of interview: Place: Duration: Name of respondent: Pierre Mérigaud Isabelle PUECH (ipuech@fepem.fr) France 1h Institution / Position: Autonom lab: hub for innovation in the healthcare and autonomy of individuals. Organisation that seeks to promote Field of expertise: adaptability of the home development of skills research and development 248

249 projects and innovative solutions for the independence of individuals. Theme 1: Current experience with implementing digital skills and ICT in care work Is it useful to provide careworkers with training in ICT? The answer is yes because these professional carers will increasingly be confronted with technologies in the homes of people losing their autonomy. They will even be in the front line. The studies that we have conducted with doctors and sociologists have shown that the elderly are not always hostile to technologies but that they are often unaware of their uses and so turn to their careworkers for help. It is therefore important that these women be trained in order to fulfil this need. Must the careworkers be technical experts or should they just be knowledgeable about how specific technologies function? This concerns the important issue of raising the profile of these jobs. The potential trainees would like their work to be more valued. They, themselves, often enhance their role by making diagnoses, showing that they are well aware that recognition comes primarily from the medical aspect of their work. This issue of raising the profile of these jobs is all the more important as recruitment will become harder if they are not more valued, as the need for home care is growing steadily. Once they have learnt the basic usages of technology, the careworkers could make an initial survey, a first evaluation of the technological needs of the care receiver. Careworkers must therefore be made aware that specific technologies can be of use in the home of care receivers who are losing their autonomy and that these do not compete with the need for human help. Theme 2: Care receivers needs The careworkers main role is to facilitate things: because of their closeness to the care receivers, they can explain to them the benefits of technology. Using technology today is becoming less complex. We all use technology without even thinking how it works. We don t need instructions because the way we deal with technology has become almost instinctive. And because technologies change, the elderly of the future don t necessarily need to learn how they work. We must nonetheless make a distinction between the technologies that help social bonds, like the internet, and the more advanced ones that can provide remote medical support and that require that care receivers have proper information and training in order to integrate these technologies in their homes without feeling that they are intrusive. With devices providing monitoring and remote support, for example, care receivers must learn what 249

250 to do in the event of a power cut and how to contact someone. Careworkers have a part in this. They must be reassuring but also coordinate the various people involved in the home. The primary need these technologies address is the need for safety: the care receiver must be safe in his/her home. The most interesting developments for the future pertain to medical after care in the home, for example after an accident when the state of the care receiver must be monitored, or, preventively, before an accident happens. Someone can be fragile without needing to go into an institution. Intelligent technologies now allow us to monitor various parameters which can be gathered and exploited by the medical staff and which can help readjust a course of action or even define one preventively. These technologies are about in-home support. But in-home support depends on the capacity for these technologies to be integrated into the home. Theme 3: Digital skills for care workers and caregivers Careworkers can perceive the intrusion of technologies in their professional environment as a constraint. They must be trained in order to avoid this. All jobs evolve, and what is needed is help to cope with the change. Which workers should benefit from what training? This question can t be answered generally but only specifically. Some careworkers need to be able to assess a situation, in order to ascertain that the care receiver is not safe and that he/she could benefit from various technologies and services that can provide reassurance. The information gathered at this stage can then be passed on and acted upon by other people. Other workers can deal with more advanced technical aspects. A crucial dimension that must be included in training courses is ethics, because this is about people s private lives and their intimacies. Moreover, these kinds of training programmes must necessarily reflect on how the jobs will evolve with the acquisition of technological fluency and with the increase in skills that results. The danger of training programmes that are narrowly technological is that they see the work of the careworker as a mere succession of tasks, which it is not. Raising the profile of these jobs also necessitates debates about their nature. Finally, increasing the profile of these jobs, through technological expertise, must lead to a financial reward. If they are better trained and better paid, these employees are more likely to be more invested in their work in the long-term. Comments, any other information: 250

251 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): ISTITUTO PER LA RICERCA SOCIALE ITALY Date of interview: 05/11/12 Place: Duration: Name of respondent: Alice Ghibellini Theme 1: Current experience with implementing digital skills and ICT in care work Francesca Di Concetto Phone interview 50 min Institution / Position: Local Health District of Porretta Terme In charge of Family Assistants Helpdesk Field of expertise: Social care work Honestly I don t see any connection between digital competences and care work. Perhaps the only field where such a connection could make sense is that I could make it easier to deliver certain kinds of training contents, for example through the use of power point presentations to be shown in class. As regards e-learning, Emilia-Romagna regional government has indeed produced a self-training DVD - though I m not sure whether this could be considered e-learning anyway the only skill requested here is to be able to start a DVD and move between the various menu items. On the other hand I know that though this training DVD is available, care workers generally do not use it: they do prefer classroom training. On the other hand there are skills such as bed-making or patient mobilisation that cannot be learned digitally! For this reason I think digital literacy might perhaps be useful in care work only for care workers to fill their downtime, or at most for entertainment, e.g., watching a film together with the care recipient. In my opinion and based on my experience it is most unlikely that a care worker use a smartphone to search the internet for information on a disease, or anything else concerned with her work. And we should also consider that one should possess quite good language skills to be able to perform an internet search! 18 So I really don t see any way to incorporate digital skills and ICT in care work. The only possible way to use technology in care work would be tele-care (e.g., pendant alarms, etc..) but these tools are used by people living alone, who do not have any caregiver or care worker. If they had a caregiver or care worker to care for them, they would not need these tools. If we enlarge the focus to include also informal caregivers, then perhaps there would be more possibilities for digital skills to have a role. Family members can keep in touch with the doctor, search for information on their relative s disease yes, this is a case when technology might be used. But this happens only when an emergency or a specific need occurs it 18 Most care workers come from non-eu countries and they often have poor italian language skills. 251

252 Theme 2: Care receivers needs Theme 3: Digital skills for care workers and caregivers does not happen on a daily basis. Care workers use the internet for much more extemporaneous needs, and they usually use them only because they are away from their homes, as a tool to keep in touch with their families abroad. Many of them come here and ask if they can borrow a computer in the ICT room to send an home, or to connect to their families via Skype. Older people generally do not have any computer in their homes so they cannot do this at the care recipient s homes. Technologies could help care recipients as far as entertainment is concerned I m thinking of DVDs and especially audio-books for visually impaired patients. These technologies can be used independently: the care worker should just help with turning the devices on and off. Another field where technologies couls be useful is tele-care (for those living alone or spending a part of their time alone). On the other hand if an older person is curious, wants to have information on something, or just wishes to see his/her grandchildren, then there should be someone doing the operational tasks on his/her behalf: searching the internet, using a menu, etc are difficult tasks for an older person. And the majority of older people don t even think of this problem since they don t have a computer in their homes I really can t think of any way digital technology could affect an older person s daily life. I don t have any personal experience of proposing technology to older people, but based on common sense I would expect them either to refuse it or to need assistance in using it. This said, I think that if an older person is in good cognitive and health conditions, using digital technologies would constitute a very important cognitive stimulus, would keep brains trained, would help them feel independent and full members of a constantly evolving society. On the other hand, it is something that is difficult to manage on one s own. Digital skills are not generally included in care workers training. We 19 provide a 40-hour course where there are no ICT modules. Self-training courses require basic ICT skills for learners to be able to access the training. In such cases, ICT and digital literacy modules are available, too, but they have the only aim is to enable learners to use the e- learning tools. The best way for care workers to improve their ICT and digital skills is the same as for everybody else: to have a more skilled person to help them (for them it could be somebody in the care recipient family who is good at using a computer though generally older people do not have a computer in their homes). 19 The helpdesk is run by the staff of a training centre (IAL Emilia-Romagna) who has been appointed to provide training courses for care workers. The courses last 40 hours and are organised as follows: 26 hours: operational care techniques; 11 hours: psychological issues (dealing with daementia patients, dealing with patients families, etc...) and employment contract issues; 3 hours: final examination and assessment. 252

253 I think the only essential digital skills for a care workers would be for properly using and supporting the older person in using assistive technology and, as additional skills, being able to use telemedicine and tele-health tools. However I would like to reassert that I see no real exigency for digital technologies in care work. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): ISTITUTO PER LA RICERCA SOCIALE ITALY Date of interview: 02/11/12 Place: Duration: Name of respondent: Daniele Guidetti Francesca Di Concetto (fdiconcetto@irsonline.it) Reggio Emilia 1 h Institution / Position: DAM Sistemi s.r.l. Chief Information Officer Field of expertise: ICT training Theme 1: Current experience with implementing digital skills and ICT in care work Though I do have experience in ICT training for older people I must admit I have never fully explored the domain of ICT and care work, and I m glad I have the opportunity to discuss with you on this important subject. Based on what I know about care work that as I said before, is not my professional domain - I think that digital skills and ICT can be important in care work just as much as they are important in any other job nowadays. Digital technology enables people to operate in a stateless mode, wherever an internet connection (computers, smartphones and tablets) is available, thus allowing them to carry out activities and tasks that would have been unimaginable only 10 years ago! On the other hand it should be considered that digital technology also drastically decreases the workers need to leave their houses to reach their workplace, but it might also decrease one s social relationships and contacts with the world outside in certain situations. This is an issue that should be considered, too. Digital literacy (and I dare say, even something more than just literacy ) is essential: enabling care workers and caregivers to know this subject matter well enough to be able to transfer their knowledge to other people (in our case, to their care recipients and older family members) would provide a fertile breeding ground for organizing training sessions to learn how to use the most common ICT tools. 253

254 As far as I know (based on my personal experience) care workers today don t use digital technology, but I don t have enough experience in this field to be able to tell you what caregiver tasks could benefit from ICT. I d like to reassert my previous statement that being digitally literate is an asset in itself since it potentially allows knowledge transfer: though this might seem odd, older people are great ICT users waiting for their potential to be put in action! Theme 2: Care receivers needs Theme 3: Digital skills for care workers and caregivers Technology is extremely important for older people. I can state this from my experience in ICT training for over 75 s. Older people are eager to learn, but they are afraid of technology. The advent of tablets is likely to lower the learning curve in such a way as to enable older people to go online and discover the Internet. Reading, playing, discovering, checking one s bank account or paying bills are only consequences of access to the web. As regards the theme of assisted use of ICT, we should consider that the world of technology is working to make internet usable, as is shown by the success of the Apple and Google app stores. Unlike traditional web, apps make easy what once used to be difficult. In a few years the near totality of the apps necessary for digital self-sufficiency will be so sophisticated that they won t need any external assistance. As regards older people s relationship with ICT, in my experience as a trainer I have never noticed any negative reactions. On the contrary, my older pupils showed great interest not only in exploring and navigating, but also in understanding Internet. Of course patience and a good pedagogical method are essential to obtain good results. It must be considered that from the point of view of learning, older people behave a bit like children: if they don t understand, they just abstract themselves. So it s not an easy task. But it s extremely rewarding when one sees the progress they make! To my knowledge, digital skills are not something that is widely taught in courses for care workers (though as I stated before, also this industry would benefit from digital technology). On the other hand tools such as YouTube or Vimeo could do much to enhance digital skills (not only for caregivers but for everyone). Basic ICT skills are essential for every job; as far as caregivers and care workers are concerned I think also online services could be useful (home banking, online payments ), as well as tele-care, tele-health and assistive technology. This should also involve a self-training effort on the part of the care workers: if training is not provided for them, they should try to join groups or experiment themselves by using these devices. Comments, any other information: 254

255 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): ISTITUTO PER LA RICERCA SOCIALE ITALY Date of interview: 06/11/12 Place: Duration: 1h 30 Name of respondent: Rosetta Mattioli Francesca Di Concetto Face-to-face interview Institution / Position: Municipality of Langhirano Social Welfare Officer Field of expertise: Health and Welfare Theme 1: Current experience with implementing digital skills and ICT in care work First of all I would like to underline that when talking about digital technology in care work we should refer to beneficiaries who may have motor difficulties but whose cognitive capability is good. In such cases digital technology surely allows people to keep informed, remain updated, play online games with others in short, they can feel they are not alone. And it is also an excellent tool for cognitive stimulation of patients in the early phases of dementia: the patients family members could administer all the memory training quizzes and tools. This would be very helpful especially for those patients who live far from one of the centres where memory training protocols are performed. These quizzes might be administered to patients at their homes. We have noticed that the possibility to be in connection with other people, communicate, exchange opinions, is very appreciated by patients with even extreme motor difficulties, paralyzed or bedridden. Anything allowing one to have one s autonomy in daily living (an electric wheelchair allowing one to move up and down the house, a computer allowing one to communicate with other even if one cannot use one s hands all this is of great importance for a person who would otherwise be bedridden and unable to move and to go out. I m thinking of domotic technology, which make life really easier. But the costs of this technology are so high that it is nearly impossible to access them. There are some patients family members who would be very willingto use certain tools if they were supplied to them free of charge. If we could have some kind of training, we could do certain things through a computer ourselves [she means the welfare operators]. I m thinking of cognitive stimulation quizzes and tools, which allow patients to maintain their reading, writing and calculation ability. If we [welfare operators] were more technological we could administer them online, update them constantly, rapidly. Some time ago I proposed to organize a few computer-aided activities mainly cognitive stimulation ones - for the patients of a senior day centre, but unfortunately my suggestion was not accepted by the operators. It is a pity. There are many games where an older person can regain contact with 255

256 his/her former life, the life of his/her younger years. For instance, the farm game. You create your own farm, you sow your own vegetables, you pick them, you buy your own cattle, and everything with no need of money! This could really become a group game for the elderly: What are we going to sow today? What are we going to buy? But then one must face the operators inability to use technology. We [the welfare services in general] train them very well in caring for the patients bodies, but not in the use of ICT. They are still convinced that an older person cannot use a computer, whereas on the contrary older people are more flexible, they become keen, they are more curious! I do believe there is a great potential in digital technology for older people, and the digital world is really something well worth getting to know. Of course there are risks, too. If one relies on technology too much, one risks to miss one s interpersonal relationships. This is something that should be considered. As regards care workers, they usually are women coming from foreign countries with very few connections except for small villages where it is easier to get to know people. They make friends with other care workers and meet during the breaks they have in their work day. Technology would surely break the routine of social care work; it would bring more sharing opportunities. I have seen older people teaching care workers how to cook our traditional dishes. Being connected would increase their complicity and convey it towards the outer world. Care workers would feel less lonely because they could have the possibility to contact their families abroad through different means than the telephone, they could read the newspapers of their countries and remain updated on what happens there. It could also be the start of a new way of sharing learing: let s try and learn together something we don t know! It would indeed become a possible stimulation activity to be done with the patients. Care workers are not digitally literate though it would be important to provide opportunities for digital literacy: care work is very heavy, and if one could succeed in making it less heavy by creating connections and other kinds of stimuli, this would help a lot.. Carers end up in a tunnel where there is depression, tiredness, sadness. Be they family members or care workers, they risk to shut themselves away in a world apart where they can see no way out. Technology would allow them to not always be shut up and seeing the same things every day but to open themselves more to the world outside. Care workers don t use technology. I ve never seen a care worker with a computer or a tablet or a smartphone. They do use cellular phones, the telephone a lot, because telephone is for them the only way to stay in touch with their family and friends abroad. What is required of a care worker is washing and dressing the patient, preparing breakfast, cleaning the house, do the grocery shopping, take patients to the toilet, take care of the kitchen garden, feeding the hens, etc. These are not tasks requiring digital competence. And family members very seldom require these competences of a care worker. What matters to them is that their relative is cared for. They don t care about cognitive stimulation, 256

257 Theme 2: Care receivers needs they just want to be sure that their relative is fed, that he is materially cared for. The rest is seen as superfluous. Socializing is not seen as essential. Only a minority of families understands the importance of these aspects: no more than 20%, One of our tasks when dealing with families is to make them understand that their older relative must be allowed and enabled to do as many things as possible autonomously, even performing simple tasks such as podding beans is an important achievement: it allows maintaining intellective capacity, stimulates participation! When I tell the senior day centre operators that I d like to propose a computer-aided activity to the patients they open their eyes wide and say: Come on! Can t you see that they re unable to move? And also what matters to families is that the patient be washed, cared for, respected. It is only when they realize that their father s or mother s mental conditions improve thanks to adequate stimulation that they understand how valuable these practices are. But this happens only in 20% of cases. This means that care workers are not required to have this kind of competence. The most important aspect is socializing. One shouldn t see digital technology just in a care worker / care recipient context but should involve also students, younger people, to teach older people how to use technology. This could be extended to dependent older people and their families too. It would be an important intergenerational exchange. A young person teaching is different from an operator teaching. Young people are less formal: they can joke, they can make one laugh, they bring new life into an older person s life. And I think that everything can be done without assistance once one has learnt how to do it. This is true for everything, not just for digital technology. I don t have direct experience of how an older person could react to technology but I can guess [laughs]. It depends on one s life experience. One who has been an assembly line worker all his life can have a different reaction from that of one who has been a clerk all his life, or of one who has been a farmer all his life. But I think that after a first wary reaction older people can overcome difficulties. Older people are more willing to accept new things than we are. Older people accept young people wearing tattoos and dreadlocks and piercing if they are respectful, friendly and considerate. This is true for technology, too. We are the ones who have prejudices against people and technology: if we see a guy wearing dreadlocks we feel suspicious, but an older person doesn t. Older people value one for what one is and they do the same with tools and technologies. They may feel puzzled at the beginning, they may be afraid of making damage, but they are willing to learn and it should be our task to stimulate their curiosity and help them learn. 257

258 Theme 3: Digital skills for care workers and caregivers Though courses for caregivers do not propose ICT modules, ICT courses are provided by the local lifelong learning territorial centres. 20 But care workers usually cannot attend those courses because they are held during their working hours. I can t think of essential digital skills unless we focus on patients with particular impairments or conditions. On the other hand I think that every skill would be useful, everything can allow one to be creative, to make new experiences. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): ISTITUTO PER LA RICERCA SOCIALE ITALY Date of interview: 05/11/12 Place: Duration: Name of respondent: Pierpaola Paolucci Francesca Di Concetto (fdiconcetto@irsonline.it) Phone interview 1h Institution / Position: Freelance ICT professional Field of expertise: e-health, AAL Theme 1: Current experience with implementing digital skills and ICT in care work Care work needs more and more ICT/digital supporting tools. Therefore, the need for ICT/digital skills is an ever-growing one. ICT and digital tools can bring huge benefits in home care work: they can make care work safer, prompter, even if one is far from a hospital. Care work (be it provided by professional staff or by informal caregivers) requires at least digital literacy, because the use of digital equipment in care work is increasing. The more complex the care required by the patient, the more complex the equipment. However, the use of personal computers and smart-phones is very widespread now even for lowcomplexity care activities: it makes it possible to bridge the home-hospital gap. 20 The Centri Territoriali Permanenti (CTP) were established in 1997 to provide training to acquire a qualification for adults both Italian citizens and foreign citizens living in Italy. 258

259 Theme 2: Care receivers needs Theme 3: Digital skills for care workers and caregivers Digital technology can constitute an important support in older people s daily lives. It can provide safety, control, prompt assistance even in one s home. Care recipients can be continually monitored even in the absence of a carer; at the same time, technology makes it possible to alert professional carers in case of need. In more complex cases, digital technologies require the presence of a family assistant, 21 but in simpler cases where the care recipient is selfsufficient and requires company, social relations, help in daily life, then digital technology really helps thanks to tools and equipment that do not require advanced digital skills and can be used independently, such as internet that allows one to remain updated on what happens in the world by reading online newspapers; skype that makes it easy to reach friends and relatives (even those living far away) and talk to them; online services made available by banks, post-office, hospital, etc. that make it possible to maintain one s social and institutional contacts. Some digital equipments require installation, maintenance, and this often means that strangers [technicians] must go to the care recipients houses to perform installation and maintenance tasks, and this might cause a negative reaction because very often both care recipients and their family assistants are reluctant to opening their houses to people they don t know. On the other hand, some tools are not very easy to use, and carers are not confident: they are afraid of not being able to use them, causing damage, or harming their care recipient. It is therefore necessary to provide careful and thorough training to both groups of users. Unfortunately there are very few initiatives or training programmes for family assistants, and the existing ones focus on operational and healthrelated aspects such as drug administration, postures, personal hygiene, etc. and not or very little on digital training. It should also be underlined that very often professional nurses and/or care workers (not only in home care but also in hospital care) are not adequately trained to improve their digital skills. I think basic ICT skills together with tele-care and tele-health are essential in care work; internet skills, using online services and managing assistive technology would also be helpful. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): ISTITUTO PER LA RICERCA SOCIALE ITALY Date of interview: 06/11/12 Place: Duration: Francesca Di Concetto (fdiconcetto@irsonline.it) Phone interview 45 min 21 Care workers privately employed by care recipients or their families are called family assistants in Italy. 259

260 Name of respondent: Maria Chiara Patuelli Theme 1: Current experience with implementing digital skills and ICT in care work Theme 2: Care receivers needs Institution / Position: Local Health District Pianura Est (Bologna) Technical Coordinator Welfare and Social Planning Field of expertise: Health and Welfare Digital technology can be used in several manners: domotics, technologies for improving patients autonomy in their homes, but also as a support to care work. For example palmtop computers are currently used by social care workers [public] to create and monitor the care plan for each patient (e.g., weekly bathing, etc.) as an organisational and communication support to update nursing homes activity planning. I can t think of any disadvantage of technology in the field of care work, whereas I think the advantages could be increased by extending the use of technology to care recipients, for them to communicate and ask for assistance by using Internet instead of the telephone for example. But these advantages haven t been developed yet. Care workers could surely use digital technologies to search for information on the task they are supposed to carry out in their daily work, as a source of information on their work. But digital literacy is surely not a priority in care work and for care workers. Apart from the use of palmtop computers, domotics is useful too, but when it comes to domotics we are not in the field of care work any more: it is something connected to the beneficiary, something autonomous that is managed by the beneficiaries themselves. The daily activity of a care worker could benefit from technology as regards access to information relevant to care of the patient, such as booking an appointment with a specialist, etc though it is the care recipients family members who usually perform such tasks. Or, they could benefit from digital technologies to search for information on activities that they must perform in their job. Internet could be a source of information on the network of the welfare service providers, to access such services, to book appointments with doctors, but also for entertainment. On the other hand, distance care tools could be used as support tools for socializing especially for some groups of beneficiaries. So the internet could be used not only as a source of information. Other need that could be responded to by technology is the need for autonomy, thanks to domotics. It is obvious that we are talking about selfsufficient beneficiaries: dependent care recipients would support and assistance for everything. I think the beneficiaries reactions could be negative only if technology were imposed as the only way to access a service. On the contrary, reactions would be positive if technology were presented as an additional tool. Everything depends on how technology is proposed and what the available tools are. 260

261 Theme 3: Digital skills for care workers and caregivers To my knowledge there is no ICT or digital training for care workers. It happens that some care workers go to the local library [where basic ICT courses are organized] and enrol in an ICT course, but they just do it for themselves, to be able to communicate with their families abroad. They don t do it because they think it could be useful in their job. In my opinion it would be essential to be able to handle tele-care, telemedicine, tele-health. Digital skills are a just means to achieve a result. Also online services and social networks could be useful, for the care worker to encourage the care recipient to use the computer to talk with their family, grandchildren etc. This is not exactly care work though I d rather say it is taking care of the care recipient s life. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): ISTITUTO PER LA RICERCA SOCIALE ITALY Date of interview: 19/11/12 Place: Duration: 1h 30 Name of respondent: Dr Paolo Tosini Theme 1: Current experience with implementing digital skills and ICT in care work Francesca Di Concetto (fdiconcetto@irsonline.it) Face-to-face interview Institution / Position: Parma Local Health Services / General Practitioner - Geriatrician Field of expertise: Health & Medicine Digital technology has surely influenced care work. For example, e- mail (or even fax, though it has become obsolete) is used by care workers and informal caregivers to request and receive medicines prescriptions. Another way digital technology has influenced care work is for instance the case of therapies such as those with oral anticoagulants, which require a blood sample taken in the mornings. At 4 in the afternoon the report is ready and it can be sent by or by fax, and the caregiver or care worker doesn t have to go to the hospital to get it. As regards technologies such as telecare, I think they are useful to patients who live alone. If patients have a caregiver or a care worker, the caregiver/care worker just dials 118 [the health emergency number]. If I were to think of an application of telemedicine in its broader sense I would make the example of a nurse who goes to a patient s house to administer an electrocardiogram. The nurse then transmits the chart to the patient s cardiologist and general practitioner. An ECG taken at dependent and/or untransportable patients domicile can be transmitted through telemedicine tools. This is an experimental project that has just started in Parma. 261

262 Theme 2: Care receivers needs Telemedicine is already operational for cardiological emergencies: a health emergency nurse administers an ECG to the patient and transmits the chart to the coronary care unit in real time so that when the patient reaches the hospital the cardiologist already has the ECG chart. In this sense I think digital technology brings only benefits. I ve noticed that the Romanian carer of one of my patients uses the computer to stay in touch with her family. This is another advantage of digital technology. Moreover care workers, such as any other worker, could benefit from digital technology also to manage their work documents. For example, sick notes can now be electronically transmitted and care workers who are employed by families, when they are ill, can receive and transmit the employer s copy of the sick note without having to go to the doctor s. For those who have a smart phone or a computer, Skype can be useful to keep in touch with their family abroad, but certainly not for caring for their patient. If care workers need to communicate with their patient s family they use the phone, they don t not skype. But if a care worker knew how to use Skype, this could perhaps facilitate the patient s contacts with children or grandchildren living far away. As far as I know care workers use technology mainly in their free time - provided SMS s are considered to be digital technology. If we consider SMS s, they surely use them monre in their free time than during working hours. On the other hand, care workers do have some free time even during their working hours in the sense that they are not always performing tasks. They cannot go out, they must stay in the house, close to the patient, but they can have some time for reading, watching television, and they would have time even for using a computer. The problem is that they often can t use one. It s a matter of competence rather than a matter of time or equipment availability. Digital technology can surely respond to needs of the care recipients, even just as regards getting documentation from doctors, municipality, etc. without having to leave the house. Older people can use a cell phone but not always can send SMS s they would need the care worker s assistance for this. As regards online shopping, it can be useful if one lives alone. If one has a care worker, it is the care worker who does the grocery shopping. Technology is useful to replace a care worker if a patient lives alone. As I see it, care workers are there because an older person has a certain level of dependency, is not self-sufficient, or has cognitive problems, so cannot be left alone. Active, energetic older people don t need a care worker. They might perhaps enjoy having some company, but they don t need to be cared for. I don t know if an older person would enjoy reading the newspaper on a tablet or would rather have the care worker go to the newsstand and buy a real newspaper there! It would be difficult for an older person to embrace new services such as these. On the other hand, services such as the one I mentioned above [digital transmission/reception of medical reports] have only pro s and no con s. I don t know if having a smartphone would be useful for an older person. They wouldn t use it to send and receive photos with What sup! But anyway, this would be something for active people, for people in good 262

263 Theme 3: Digital skills for care workers and caregivers health! The typical older person that is cared for by a caregiver or care worker is generally in bad health or has bad cognitive conditions, is partially or totally dependent. I know about ICT courses for older people but not for care workers. There are Itaian language courses for care workers, but not ICT courses, not even on an informal level. On the other hand, being able to use a computer or a tablet, internet, , and also word processing is essential for accessing the services I mentioned above. Using online services could be useful also for the care workers themselves, to check their social security situation, check if their employers have paid for their social security, etc. Uses that are connected to their identity as workers, as individuals; not just connected to the person that care for. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: LSA/LIKTA Country: LATVIA Reporter (+ Martins Etkins,, martins.etkins@samariesi.lv, address): Date of interview: Place: Riga Duration: 2 h Name of respondent: Kalvis Ozolins Institution / Position: LSA/technician, operator Field of expertise: Social and care service Theme 1: Current experience with implementing digital skills and ICT in care work 1a) In general, what do you think about the relationship between digital skills/ict and care work? Use of DT can make easier daily care work, make it more time efficiency. DT can make care work more interesting and can entice new care workers. But DT should be very easily operated. It must be well understandable for elderlies. 1b) If you were to describe today s care worker s typical day, how would the use of ICT occur in it? In Latvia care workers use mobile cell phones to communicate with care recipients, if it is necessary. And there are telecare services, which cooperates with care sector very well. How relevant is digital literacy for today s care workers and caregivers? It is not very important, because in Latvia aren t many DT integrated in care work. In your experience, what are the typical circumstances under which today s care workers approach digital technology? Mostly they are using if it is necessary for their personal needs. Can you tell me more about typical tasks and procedures in a care worker s day that require digital literacy? Planning, organizing visits with care recipients. Cooperation with family doctor and relatives. 263

264 Theme 2: Care receivers needs 2a) What, in your opinion, are the care receivers needs that could be met using digital technology? To contact their relatives. Brain games and other activities. For communication with other elderlies. Faster will run everyday time, active ageing Which kinds of digital technology could be used by care receivers themselves, and which would require a care worker s assistance? Need assistance for tablets, smartphones, PC. 2b) How do you think care receivers will react to services involving digital technology? Not all care recipients. Can you describe your experience with care receivers acceptance of ICT-based services and activities? Yes, there are elderlies, who are learning computer skills, because they want to be in touch with relatives, to read news, TV programs e.t.c. What are the pros and cons here? If they are sitting on a computer all day long, they will come to be a passive on physical activities. Theme 3: Digital skills for care workers and caregivers 3a) Presently, how are digital skills incorporated in care workers qualifications? In my opinion there aren t any IKT requirements Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): LSA/LIKTA LATVIA Date of interview: Place: Duration: Name of respondent: Aivars Ritovs, Martins Etkins, Mara Jakobsone martins.etkins@samariesi.lv, mara.j@dtmedia.lv Riga 1,5 h Institution / Position: NFC team, CEO Field of expertise: ICT and mobile technologies, NFC technologies 264

265 Theme 1: Current experience with implementing digital skills and ICT in care work In general, what do you think about the relationship between digital skills/ict and care work? Until now in Latvia and also in many places in Europe digital skills and ICT are used very poor in care giving and other similar professions. In Latvia, as much as i know, the only ICT device in care givers daily work is cell phone, which is used basiclly to call and recieve calls. Digital technologies can significantly improve organisation of care giving and service quality. For example NFC technologies already allows us enumerate office hours as well as reckon given services in real time. Now we are introducing NFC (Near Field Communication) technologies in care givers work in Italy, Montova city, for optimise and reckon care workers job and to control services quality. Can you think of specific advantages and challenges that digital technology poses to the field of care work? Digital technologies can improve jobs quality and save resources. E..g., in Italy 80 care givers can be coordinated by one person (before thera was 1 person for 20 care givers). The challenge is expenses of the introduction of digital technologies, although precisly defining neceserry parametrs it is possible to reduce these expences, e. g., the cheapest smart pohne which works with NFC technologies costs ~ EUR. How relevant is digital literacy for today s care workers and caregivers? In practice, care givers computer skills are not important, because technologies used by them are very easy to use. The manager of care giving service must have medium level computer skills. In your experience, what are the typical circumstances under which today s care workers approach digital technology? In Latvia, as much as i know, the only ICT device in care givers daily work is cell phone, which is used basiclly to call and recieve calls. Can you tell me more about typical tasks and procedures in a care worker s day that require digital literacy? Theme 2: Care receivers needs Planning and accounting of office hours, accounting of the range of services and controle of fulfillment. Can you tell me more about typical tasks and procedures in a care worker s day that require digital literacy? By using DT, it would be possible to contact clients family to order some exta care services.also DT may provide confirmation mechanism of service delivery from care client. In care receivers daily lives, how could digital technology be of help? Use of DT could improve the life quality of care clients by giving some new ways of communication with relatives or health and care specialists. Which kinds of digital technology could be used by care receivers 265

266 themselves, and which would require a care worker s assistance? Absolutly individually. How do you think care receivers will react to services involving digital technology? The most important factors are easiness in use and intelligibility, but elderly people may have some problems with DT use. Can you describe your experience with care receivers acceptance of ICT-based services and activities? I do not have such experience in Latvia. Theme 3: Digital skills for care workers and caregivers Which digital skills and competences would you name as substantial for care workers? For care operators it is enough with basic computer skills. Organizators and managers need more skills to work with ICT. What digital skills are taught in current VET programmes in the field of care work? I am not informed abotu that. Are there any non-formal possibilities for care workers to enhance their digital skills? I am not informed abotu that. What should all care workers know, understand, and be able to do in the field of ICT? All care givers must have skills with the simplest smatphones applications. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): LSA/LIKTA LATVIA Date of interview: Place: Duration: Name of respondent: Ervins Alksnis Martins Etkins, Mara Jakobsone martins.etkins@samariesi.lv, mara.j@dtmedia.lv Riga 2 h Institution / Position: Riga City Council, Welfare department, head of service Field of expertise: Social and care service, municipal care 266

267 Theme 1: Current experience with implementing digital skills and ICT in care work 1a) In general, what do you think about the relationship between digital skills/ict and care work? At the moment in Latvia there is no any connection between ICT, care work and computer skills. In the care work organization level of the use of ICT is minimal. Maybe in next 5 years ICT and e-skills could enter in care givers daily routine. At the moment Digital Technologies ( DT ) can t replace those jobs which care givers do by his hands. The benefits of DT is possibility to do the same functions, in which no physical contact is needed, with less costs, e. g. online gymnastics lesson, online consultation with a doctor, medical specialist. 1b) If you were to describe today s care worker s typical day, how would the use of ICT occur in it? Care givers routine now elapse by doing their direct duties in communication with clients and the only ICT used in this job is cell phone, which provides care givers communication with care managers and organizers. How relevant is digital literacy for today s care workers and caregivers? Care givers digital literacy is absolutely unimportant at this moment. Computer skills are important only for care managers and coordinators. In your experience, what are the typical circumstances under which today s care workers approach digital technology? In my experience care givers, who actually does the caring, use only cell phones for calling. Can you tell me more about typical tasks and procedures in a care worker s day that require digital literacy? At the moment there is no such care giving system or defined rules, where DT skills would be needed. Theme 2: Care receivers needs 2a) What, in your opinion, are the care receivers needs that could be met using digital technology? At the moment the biggest obstacle in DT use for the good of care client is the lack of DT literacy between seniors, because their skills in the most of cases ends with use of cell phones. Which kinds of digital technology could be used by care receivers themselves, and which would require a care worker s assistance? It would be appropriate if care clients could acquire ICT so they can use most easiest computer programs ( , browsers, ect. ) and specially adapted programs and equipment. Which kinds of digital technology could be used by care receivers themselves, and which would require a care worker s assistance? Possibly, at the first client may want to use ICTequipement and ICT- 267

268 based services and activities only when care giver is there and can help, bet when the client will be used to these technologies, he could use them all by himself. Also we could introduce some special carpets, which would automatically signalize if the client is dropped, for stroke patient and other risk groups. Another example is CCTV systems for clients safety, but there we need to think about clients privacy 2b) How do you think care receivers will react to services involving digital technology? Likely this reaction would be fear to use, because they do not know what is it. Also it is fear to broke technologies and this is why elderly people doesn t use it at all. It is very important that technologies are simple the same as with cell phones, elderly people love cell phones with only two functions calling and SMS. Can you describe your experience with care receivers acceptance of ICT-based services and activities? Seniors with a big interest learn how to use , internet browsers and pay bills in the internet. What are the pros and cons here? I the care client is opened and free minded to use of ICT, then ICT can improve care giving quality and a quantity of services. The introduction of ICT asks for significant costs, however. Theme 3: Digital skills for care workers and caregivers 3a) Presently, how are digital skills incorporated in care workers qualifications? In care qualification there is embedded only minimal computer skills most popular computer programs (MS Word, Excel, Outlook). In caregivers work there really have no demand for these skills from employer. 268

269 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): LSA/LIKTA LATVIA Date of interview: Place: Martins Etkins, Mara Jakobsone Riga Duration: 1,5h Name of respondent: Anda Masejeva Theme 1: Current experience with implementing digital skills and ICT in care work Institution / Position: Senior Officer, Ministry of Welfare, Department of Social Services Field of expertise: Social services, state policies in social care and services In general, what do you think about the relationship between digital skills/ict and care work? The Classification of occupations does not ask any specific IT skills from caregiver. The situation is a bit different with social caregivers, where professional qualification is equivalent with First level higher professional education and means that some IT skills are required. Care giving organizator s and manager s IT skills are in a certain level, because they use most popular computer programs in their daily work. In social care centres care workers IT literacy is low and, and IT skills are common only the in the management level. There is some difference between care workers in Riga and care givers in other regions in Riga and in some of the biggest cities of Latvia, most of the caregivers have some IT skills. In your opinion, how have digital technology developments influenced the field of care work? Digital technologies could significantly improve care giving planning and management. Also it could improve the quality of services by introduction of equipment with control functions (e. g. life and health monitoring and control). Can you think of specific advantages and challenges that digital technology poses to the field of care work? Introduction and more active use of digital technologies could improve circulation of information between specialists who work with one client, so it could improve a quality of care as well as help planning the most suitable manipulations. The use of digital technologies could improve the control of quality and could help to see if all the jobs are done. By using DT it could be easier to react on critical situations happening with clients. The biggest minus of DT are the costs. Can client and the system of care giving afford it and will it bring economical effect too? 269

270 If you were to describe today s care worker s typical day, how would the use of ICT occur in it? The use of ICT depends more on the founder of care giving institution: in care giving centre funded by state, IT skills are connected with management, accounting and reports. How relevant is digital literacy for today s care workers and caregivers? I already told about formal IT skills of formal caregivers, bur skills of informal caregivers are very different, because in this group there could be an elderly care giver without any IT skills and a relative, who is an IT expert. In your experience, what are the typical circumstances under which today s care workers approach digital technology? Care givers use very little, in Country Social Care centres care givers does not use IT at all, in private institutions this situation is a bit better. Can you tell me more about typical tasks and procedures in a care worker s day that require digital literacy? Care givers ICT skills in daily work would be useful: 1) working with some technical aid resources, e.g. automatical beds; 2)filling in information about client, his health and manipulations done; 3) helping client to enjoy his free time possibility to use Skype and social networks. Theme 2: Care receivers needs What, in your opinion, are the care receivers needs that could be met using digital technology? Digital technologies for care clients could: 1)provide and improve communication with relatives, friends, health and care giving specialists, especially for those clients with movement disorders; 2)provide help and to control life, health and security control; 3 )improve their care and life quality, by using varied technical equipment. How do you think care receivers will react to services involving digital technology? I am sceptical, if care clients could easy accept services where digital technologies are needed: 1) it is not easy for elderly people to learn and approve anything new; 2) many of care clients can t afford technologies because of financial aspects; 3)most of the clients has no skills and experience how to use IT. Can you describe your experience with care receivers acceptance of ICT-based services and activities? It is not an example exactly about care recipient, but it is very important and actual. IT skills often are used to ask for social assistance by filling application 270

271 Theme 3: Digital skills for care workers and caregivers forms in the Internet. Later, after some checking, it s getting clear that actually this person is abroad and can t even receive our services. What are the pros and cons here? There are 2 important facts that must be noticed when ICT will be used to improve care clients connection with other people: 1) When all the needs for socializations will be satisfied with help of ICT, it will not be necessary to go out and meet other people in real life, so the physical health of client can grow worse. 2) Skills to communicate with other people in person can get worse and in case of that grow social isolation. The most important thing is the information security and it must be in a very high level. Our care clients are unprotected and often suffer from emotional abuse and physical danger, so the treatment of the information security in this case must be as important as child security in the internet. What digital skills are taught in current VET programmes in the field of care work? In the caregiver education programs there are included only with people s physiology, psychology and health connected themes. Which digital skills and competences would you name as substantial for care workers? At the moment it would be necessary: 1) computer skills in general to use MS WORD, Excel and some special software for care givers, that is connected with customer data input and receive; 2) it would be great if they could use some special mobile applications. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: Country: Reporter (+ address): Date of interview: Place: Duration: Name of respondent: Dace Veikina LSA/LIKTA LATVIA Martins Etkins, Mara Jakobsone martins.etkins@samariesi.lv, mara.j@dtmedia.lv Institution / Position: Board chairman, "Latvian Nurses and nursing assistants' union of professional organizations" Field of expertise: nursing services, ambulatory medical care,, care services work organization 271

272 Theme 1: Current experience with implementing digital skills and ICT in care work In general, what do you think about the relationship between digital skills/ict and care work? The situation concerning IKT s link to social work is grave there s practically no link whatsoever: no computer program has been developed and there is nothing on offer. There are only a few programs for ambulatory medical care. At the moment the care workers are using mobile phones, some of them also internet ( for communication), the ones in charge use MS Excel and Word to prepare the reports. In your opinion, how have digital technology developments influenced the field of care work? The use of digital technology could reduce the amount of paper used in the work process, as well as reduce the amount of time spent in preparing reports people who organize work spend approximately one week per month preparing reports. The use of DT could also improve the information flow, for example, it could be possible to send the report on a patients health to their General Practitioner quickly, which, if sent by post, could take several weeks. Can you think of specific advantages and challenges that digital technology poses to the field of care work? I wouldn t know. How relevant is digital literacy for today s care workers and caregivers? Most care workers cannot use a computer, and also their qualification does not require from them to be able to do so; some even have problems with the use of more complex mechanical household items. If you were to describe today s care worker s typical day, how would the use of ICT occur in it? At the moment IKT does not play any role within care work, if only a very small role in the management level. Can you tell me more about typical tasks and procedures in a care worker s day that require digital literacy? 1) Reports of the tasks performed, accomplished; 2) Planning of the work process; 3) Creating a database (inputting the data) concerning the patients status and needs, also the procedures which are being offered; DT could also be used to support the care worker in some of the everyday tasks they have to fulfil, such as writing up a shopping list, which could otherwise take an unreasonable amount of time (up to 30 minutes) 272

273 Theme 2: Care receivers needs What, in your opinion, are the care receivers needs that could be met using digital technology? You can divide those who receive medical care into two groups: The more serious cases where the patient is immobile/bed-bound: in order to take care of them, functional beds are most useful ones which help to change the position. Simple means of communication would come handy also for patients to call for help and also make phone calls. Where it comes to the less serious cases clients who are relatively selfsufficient and with lesser constraints on movement, the most relevant would be technology which would enable their communication with the outside world their friends and relatives, and also technology which would offer virtual walks outside and various games. In care receivers daily lives, how could digital technology be of help? The use of DT could most efficiently improve the communication between the patients and their relatives and friends, as well as with the care takers and medical staff. Which kinds of digital technology could be used by care receivers themselves, and which would require a care worker s assistance? I imagine that, for example, the insulin patients could use the speech boards without assistance. Or some other IT solutions to make it easier to create a shopping list. How do you think care receivers will react to services involving digital technology? If we would instruct the patients, I believe their response would be positive. But in reality we have to take into account that there are problems in these households, such as alcoholism, bad relationships with relatives, violence and so on, which would pose additional risks Can you describe your experience with care receivers acceptance of ICT-based services and activities? Going by the current observations I have to conclude that there are clients who use internet but very, very rarely. They mostly use mobile phones, but mostly just for calling. On several occasions clients can use the functional beds. Representative of the use of internet is the fact that on average only 3 applications per month are received by , which most of the time is due to people s unwillingness to trust the virtual communication. 273

274 Theme 3: Digital skills for care workers and caregivers Presently, how are digital skills incorporated in care workers qualifications? At the moment there is not a lot of it taking place the medical staff and the social workers have access to long-distance learning programs. Digital skills are only just becoming a part of the professional skills used in this area. It is also important to educate the relatives of the patients, to create instructive videos, which would describe and show how to perform simple tasks to help the patients. What digital skills are taught in current VET programmes in the field of care work? I cannot tell you exactly you can definitely have a look at where you can look through several descriptions of the offered courses. Which digital skills and competences would you name as substantial for care workers? First of all, being able to work with programs such as MS Word and Excel on a basic level. Even these tasks currently pose a difficulty on many. Secondly, ability to use internet browsers in order to find most necessary and up to date information concerning the area they work on. In reality these tasks currently pose a problem to even middle level specialists in the field. Comments, any other information: 274

275 Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: TELECENTRE Country: EU Reporter (+ address): Date of interview: Place: Duration: Name of respondent: Institution / Position: STEPHANIE JRC-IPTS/RESEARCH CARRETERO FELLOW Field of expertise: INFORMAL CARE, LONG TERM CARE Theme 1: Current experience with implementing digital skills and ICT in care work Theme 2: Care receivers needs Extend the space if needed. I don`t have experience in doing this work on the field, but studies (see Carretero et al., 2012) show that carers have difficulties in using the ICT, because they do not have good digital skills. In the case of formal carer, it also exist a reluctance to use them, because ICTs involved a change in the organisation of the delivery of care. Carers can use ICTs for different kind of activities mainly to help them for the independent living of the elderly, to allow them for social activities and relationship for families and friends, for acquiring information and competences, and to coordinate the different social and health care services. Carers need to have digital skills, the use of ICT can provide a lot of benefits doing more efficient their work, but also improving the quality of care and their quality of life Older people have different needs, mainly focused on carrying out activities of daily life: basic activities of daily living (ADLs), such as bathing, dressing, and getting in and out of bed and with instrumental activities of daily living (IADLs), including household chores like meal preparation and cleaning; life management such as shopping, money management, and medication; and transportation. IADL are the main activities that ICT can help elderly people. (I suggest to have a look at the reports of ANCIEN: Mazzeo et al. (2012). Role and potential influence of technologies of the most relevant challenges for long-term care. And Rossi et al., (2012): Technological solutions potentially influencing the future of long-term care. They are both available online). Care receiver can be reluctant to use new technologies, because they feel unsecure. We saw in the CARICT study that for example for ACTION in Sweden (use a video system through which formal care staff can communicate with carers), it was a success for the acceptance of the ICT service to present it as an assistive device to help the elderly in their day to day life. 275

276 Theme 3: Digital skills for care workers and caregivers Carers need to receive training in digital skills to use Ict based services for domiciliary care. Training programmes are needed for the range of care professionals involved to support carers, but also to help them learn new working practices and the value and limitations of the new tools. The deployment of ICTs requires that those directly involved acquire a range of specialised knowledge and competences. They must also have access to IT infrastructure. This is challenging as we are working with people with low digital competences and there is a lack of technological infrastructure available and financial resources to acquire IT materials (see Carretero, S. et al. (in press). ' Can technology based services support long-term care challenges in home care? Analysis of evidence from social innovation good practices across the EU CARICT Project Summary Report, IPTS, to be published at Comments, any other information: I highly suggest to revise Carretero, S. et al. (in press). ' Can technology based services support long-term care challenges in home care? Analysis of evidence from social innovation good practices across the EU CARICT Project Summary Report, IPTS, to be published at Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: TELECENTRE Country: EU Reporter (+ sweber@digitale-chancen.de address): Date of interview: Place: Berlin Duration: 1h Name of respondent: Institution / Position: Project management Field of expertise: Seniors/Youth/Social Media Theme 1: Current experience with implementing digital skills and ICT in care work Recently, there have been two projects that we have been carrying out with: - In one project, we equipped senior living facilities with tablet pc device and an internet flatrate, giving them the opportunity to enhance their own life quality by the use of ict. - In another project, we consulted senior residencies in installing an iit infrastructure in their facilities and implementing courses or other activities to the seniors. 1. There is a strong connection, since care work is still not as digitally determined as it could be. Care documentation, observing blood values, and body functions can all be automized and therefore have a lot of potential in enhancing the care givers work. Taking pictures of wounds, documenting, which patient you already have been visiting and how many minutes this took. Care givers belong to the professional groups who are walking a lot in their everyday life all this information can directly be transferred to a central server and synchronized with it without having to walk from the are receivers room to the office and back again. 276

277 Theme 2: Care receivers needs Theme 3: Digital skills for care workers and caregivers 2. It is difficult to generalize when it comes to the care receivers needs, but a lot of them have reduced mobility. The internet can outbalance the existing mobility deficits. It can enhance the life quality of seniors with simple tools. The internet is a medium that is based on experience everyone has to try it to see the benefits of it. This is why the care givers need to have a good personal contact with the seniors to find out what they are interested in. Then it will be easier to give them tools to communicate with friends that are living in other cities, relatives that do not live nearby. They can do their whole communication with public administrations via the internet, looking up the public transport system to gain back personal freedom and again: there are always things, that have personal relevance for every single care receiver, be it regional history of just hearing the sounds of animals. Virtual city tours via Google Street View or an assisted Skype Call are not demanding a lot of IT skills, but have the potential to increase the life quality of the care receivers. Observing IT instruments can support care receivers to live independent in their own flat since e.g. if a care receiver is having a breakdown, an emergency call can be automatically sent off. If the care workers can create personal relevance for the care receivers and are patient in showing them the potential of IT, there will be no problem in introducing the new technology to older people, especially since new tablet devides can tear down existing coordination barriers like the usage of a mouse and the - Care workers belong to a group, whose everyday work is not characterized by the usage of IT. The usage of IT will probably increase the next years since there i a lot of catch up potential in supporting the daily routines and automization process in care documentation and control. Still, the required knowledge is basic and demands offering the care givers to receive basic digital literacy skills. You have to differentiate between IT skills, that can be used for the care-giving work and between the IT skills, that can be used in activating seniors in their leisure time. The first IT skills are simple IT skills that refer to the use of care documentation applications. the second range of IT skills is characterized by a certain overview of which services exist in the internet. Based ion this, the care givers cancreate course offerings or other activities for seniors in their leisure time that enhance their everyday life. For care givers that are working in that field, it is necessary to have a good overview about the services but also to have an idea of privacy, data protection and all the other things the internet has to offer. Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: TELECENTRE Country: EU Reporter (+ address): Date of interview: Place: 277

278 Duration: Name of respondent: Andrea Schmidt Theme 1: Current experience with implementing digital skills and ICT in care work Institution / Position: European Centre for Social Welfare Policy and Research/Researcher Field of expertise: ICT-based solutions for informal caregivers and privately paid carers Relationship between digital skills/ict and care work: It is important to distinguish three different perspectives when talking about ICT skills in care work: (i) the older person s view (user), (ii) care workers views, in the formal sector, (iii) caregivers views (both informal carers and privately paid carers). For each of these stakeholders there is a different benefit of the use of ICT. Another big factor to be considered is the type of limitation that is dealt with: the degree of physical and/or mental limitation in health of an older person determines to a large degree which kind of ICT can or should be used. I will focus on the advantages and the use of caregivers: from an analysis of initiatives in European countries on the use of ICT it can be said that digital technology has started to influence caregivers work not to a large extent so far, but a lot of potential is seen by the people involved. For example, distantly living family caregivers may use skype to communicate with their older relatives, thus keeping them integrated in their family life despite not living in the same place. Also, for carers of dementia patients it can be very helpful to have sensoring technologies installed in the older person s house to reduce the need for constant presence in the household. Data protection issues as well as questions of adaptability of the older person s house should be always kept in mind, however. Finally, in cases of physical limitations, ICT can help to maintain older people active and selfconfident longer, for example by providing them with an emergency wristband by which help can be called immediately in case of need e.g. by pushing a button. These solutions have been among the first ICT solutions in care and are established even in countries with otherwise limited use of ICT for care of older people. IIn all cases, however, it is of utmost importance to ensure the political commitment of public authorities to assist in the funding and development of ICT solutions. Otherwise industrial representatives may refrain from implementing innovate solutions too early, or withdraw after pilot-testing. Theme 2: Care receivers needs The most important needs addressed via the use of ICT for family carers are: a) The need to engage with others despite having to care for someone. Given the expected increase in prevalence of dementia and other mental diseases it is of huge potential to have ICT solutions tackle also light physical needs of older people. That is, a dementia patient may need constant supervision despite being physically active and healthy. In these cases family caregivers easily become excluded from social life and/or the labour market. ICT solutions (e.g. monitoring mechanisms) may help to overcome their exclusion. b) The need for training. ICT offers ample possibilities for online courses, e.g. via video or interactive tools to train family caregivers and privately paid carers (e.g. migrant carers). This could ultimately improve the quality of care, the well-being of carers/their qualification, and the integration of carers. c) The need for a better integration of formal care sector, volunteer 278

279 organisations, health care sector, and family caregivers. Some German initiatives (e.g. SOPHIA) have shown that ICT tools offer potential to connect the formal care sector, informal carers and volunteer organisations better. For example, there can be a video tool and a wristband by which the older person can ask for help (from local care organisations or volunteers) in cases of need, instead of having to contact informal caregivers. Especially the integration of volunteers is crucial in times of scarcity of staff in the long-term care sector, and these solutions should be explored further. Theme 3: Digital skills for care workers and caregivers Acceptability It is important to involve caregivers and their families in decisions over which solution to buy and/or install. Especially in cases of having to install monitoring or sensoring systems (videocams) the adaptability of the house and the design are important. Older people may not be able or willing to change their daily habits or see their environment changed. At the same time, studies in Sweden have shown that formal care workers also need to be trained when dealing with ICT solutions, e.g. in case of tools where older people may connect directly with formal care organisations. No information about the current integration of digital skills in care workers training and/or curricula. Comments, any other information: See IPTS study on CARICT project: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: TELECENTRE Country: EU Reporter (+ Morten Lembke ml@aeldremobiliseringen.dk address): Date of interview: Place: Copenhagen Duration: Name of respondent: Rikke Samsung Institution / Position: Copenhagen council careworker Field of expertise: Careworker private homes 279

280 Theme 1: Current experience with implementing digital skills and ICT in care work Extend the space if needed. The use of computer technology gives an increased control as more job functions can be registered. The staff digital understanding, is essential in order to benefit the full use of IT s potential. It is important to be able to see the reasons and why s. Digital skills and implementation of technology most be developed in coherence with staff as well as receivers. Digital solutions can increase the service level given to the receivers but it cannot substitute the human contact and care. Theme 2: Care receivers needs IT solutions can enable the receivers to take more control of their own situation. IT solutions can give the receivers better understanding and more information of their own situation. Digital solutions can improve life conditions Theme 3: Digital skills for care workers and caregivers Training, training and training. Training so that they technical can operate the various digital systems. Learn to see the advances and possibilities in using digital solutions. Specialized platforms and systems demands specialized education and training. Training must be taylor made. Employees most have understanding and experience with course and effects Comments, any other information: Carer+ Report Phase 3: Semi-structured interview transcript Partner organisation: TELECENTRE Country: EU Reporter (+ rmcloughlin@vocal.org.uk (Rosie Mcloughlin) address): Date of interview: 5/2/2013 Place: Edinburgh Duration: Name of respondent: Rosie McLoughlin Institution / Position: Information manager, VOCAL Field of expertise: Work with unpaid carers (family members, partners, friends) 280

281 Theme 1: Current experience with implementing digital skills and ICT in care work Extend the space if needed. 1a) ICT provides many relevant and cost effective solutions within health and social care, supporting legislative and policy developments in areas such as personalisation and tailoring support to individual needs, selfdirected support and integration of health and social care. It also presents challenges for carers who are offline or do not engage with technology. This is particularly relevant as government and local authorities are increasingly using technology to communicate key messages and information. There is a social and economic divide between carers who engage with technology and those who choose not to / or unable to engage and there is a need to support this gap with resources and training. 1b) Unpaid carers are increasingly using ICT / digital technology to support their knowledge and build confidence in their caring role through information websites, e-learning and training, care management/coordination applications and Telecare. , Skype and other electronic forms of communication are tools that many carers use on a daily basis to keep in touch with family and friends. Websites such as information sites may not form part of their daily routine but may be used to deal with changes in the caring situation, book courses or to get more information about a particular condition. For carers whose homes are fitted with Telecare devices detectors, alarms etc these devices form part of everyday life. Theme 2: Care receivers needs 2a) n/a Theme 3: Digital skills for care workers and caregivers For unpaid carers, there are no specific digital skills qualifications, although there is support available through voluntary organisations, local authority libraries and social enterprises. Substantial digital skills for unpaid carers include the ability to set up and use and internet, including e-learning modules, video and audio. Ability to confidently set up online accounts for shared networks (eg. care coordination) and to engage with Telecare and Telecare devices. Advantageous digital skills include accessing and using social networking resources. For paid care workers, IRISS (Institute for Research and Innovation in Social Services) recently conducted a survey of ICT usage in health and social care. They concluded that access to social media and communication, audio and video, and support to enable collaborative and partnership working were essential skills for health and social care workers. 281

282 The report found that a substantial proportion of practitioners working in social services are missing out by being denied access to these communication channels. Issues included hardware (computers not enable for sound), firewall restrictions and blocking of social networking sites. Comments, any other information: 1/a In general, what do you think about the relationship between digital skills/ict and care work? In view of the various problems arising in connection with ageing, it is now quite clear that care in the future will be inconceivable without ICT. Nevertheless, in general it is important to emphasise the heterogeneity of ICT devices. There are devices widely in use in both the old and new member countries in formal care, either incorporated or in the process of incorporation into the care system, that provide security for the recipient of care and are important for both formal and informal carers, that are fully accepted and easy to use for both the carers and the elderly (such as the emergency alarm systems). Market actors too have taken up the production and further development of this type of devices. Very costly new devices have also appeared and are being further developed, e.g. devices monitoring the elderly. In contrast, the various ICT opportunities offered by the internet to assist care are less well known in the new member countries. The internet has become an integral part of the life of young people, but the level of internet skills is much lower among the middle-aged and very low in the case of the elderly (in Hungary, for example, statistical data show that only 5% of the older age group use a computer). A considerable proportion of carers are middle-aged or older. Often they do not have computer skills or even access to the internet. Two groups must be distinguished among the elderly in this respect. Increasing emphasis is being placed on acquiring digital skills among the active elderly and there are many programs assisting this. But society (family, young people mainly over 25, carers, market actors) regards elderly recipients of care as being no longer capable of learning, considering them incapable of acquiring internet skills. _ In your opinion, how have digital technology developments influenced the field of care work? International and national projects carried out in the recent past in this area unequivocally confirm the positive impact of digital technology on care receiver, formal and informal carer and the good examples found are speeding up further research and dissemination. (AL projects, e.g. HAPPY Ageing, CARICT, Skype Care/Hungary; Help the helpers/hungary) _ Can you think of specific advantages and challenges that digital technology poses to the 282

283 field of care work? Advantages: promotion of reconciliation of care and work, social integration of carers and or care recipients, ensuring more leisure time and social participation of carers, improves the quality of life of both carers and care recipients. 1b) If you were to describe today s care worker s typical day, how would the use of ICT occur in it? ICT appears in a care worker s typical day in Hungary only in the case of home care with emergency alarm system that has been a supplementary part of home care since It is widely available throughout the country but it nevertheless missing from home care in many areas. Its further spread can be slowed down by the manner of financing, the system of applications for financing, and the demand for the service. As a consequence, this form of ICT does not appear in the carer s daily activity, but only in case of need. How relevant is digital literacy for today s care workers and caregivers? See above. _ In your experience, what are the typical circumstances under which today s care workers approach digital technology? They accept with confidence the widespread and known devices, urge their wider use and consider them useful. They are mistrustful of the opportunities offered by the internet or not aware of their significance because many carers do not have skills of this kind, do not know the care possibilities inherent in ICT and/or the necessary infrastructure (internet access) is lacking. _ Can you tell me more about typical tasks and procedures in a care worker s day that require digital literacy? See the problem mentioned above. 2a) What, in your opinion, are the care receivers needs that could be met using digital technology? To promote daily activity, it helps them to be more active, to help to counterbalance the deterioration of physical and/or mental health, to maintain interpersonal contacts, it provides security, improves orientation, ensures meaningful use of time. _ In care receivers daily lives, how could digital technology be of help? _ Which kinds of digital technology could be used by care receivers themselves, and which would require a care worker s assistance This has been best explored by a new model programme in Hungary. The aim of the Skype Care project ( ) was to end the social exclusion of sick lonely elderly persons with limited mobility, living alone, suffering depression and receiving LTC from formal carers, but who were digitally illiterate, by teaching them to use the possibilities offered by Skype and the internet. The research applied an entirely new method by involving 16-year-old volunteers thoroughly familiar with modern digital technology to provide regular help for the elderly in learning. The positive result of the model programme: the elderly acquired the same ICT knowledge and skills as the young, their loneliness ended, their network of interpersonal contacts greatly expanded, they found a new daily activity (3-5 hours daily) and goal in life, 283

284 they were re-integrated into society within a short space of time (by the 6th month). This was achieved basically with the help of the young volunteers, and after a while led to the reintegration of the elderly by themselves. The care costs were reduced (there was no need for medication against depression, for hospitalisation, etc.). The care activity of the formal carers was reduced (there was no need for mental care). Mental care and monitoring also became easier for the family who gained more free time. How do you think care receivers will react to services involving digital technology? It depends on the ICT device concerned. Accustomed, familiar devices are sought and popular (e.g. the emergency alarm), those they are less skilled at using are not popular because they often do not meet the needs, and their use is generally too complicated. Most elderly care receivers are afraid of the internet and the computer and thus of the solutions linked to them (they do not even like to turn on the PC), they think it is detrimental to the health (in extreme cases they are afraid it will infect them with a virus) or that it harms the environment (e.g. the mouse will eat their food). 3a) Presently, how are digital skills incorporated in care workers qualifications? At present this is not yet a criterion. A big Hungarian non-profit organisation, the Hungarian Maltese Charity Service is elaborating a non-formal internet programme (Help the helpers) that provides practical help for carers in many different areas of care, transferrable immediately to countries of Central Europe with material in their own languages. _ What digital skills are taught in current VET programmes in the field of care work? See the answer above. _ Are there any non-formal possibilities for care workers to enhance their digital skills? See the answer above. 3b) Which digital skills and competences would you name as substantial for care workers? Computer and internet skills. Which additional digital skills and competences would you regard advantageous for care workers? If they have the above skills, they have the knowledge needed to use a very wide spectrum of ICT devices. All carers should have such skills. 284

285 Phase 4: Results of the quantitative analysis of digital/ict skills of care workers and caregivers Author Dr. Petra Ziegler Survey period September 2012 November 2012 Participating partner organisations EOS (RO), IFEF (FR), IRS (IT), LIKTA (LV), LSA (LV) 285

286 TABLE OF FIGURES Figure 1 Questionnaires received by partners (in total numbers) Figure 2 Respondent s job Figure 3 Respondent s level of education Figure 4 Respondent s years of experience in care work Figure 5 Respondent s country of origin Figure 6 Overall level of digital/ict skills Figure 7 Skills in management Figure 8 Skills in working with text processors Figure 9 Skills in working with spreadsheet processors Figure 10 Skills in working with presentation software Figure 11 Skills in searching and using information on the Internet Figure 12 Frequency of using online communication tools Figure 13 Frequency of using social networks Figure 14 Frequency of working with digital media Figure 15 Frequency of using smart phones and/or tablets Figure 16 Use of devices (multiple answers allowed) Figure 17 Usage of applications (multiple answers allowed) Figure 18 To perform your job well, your level of digital skills is: Figure 19 Tasks that could be carried out better if supported by digital technology/ict306 Figure 20 Opportunities to learn and train digital skills Figure 21 Interest to learn digital skills Figure 22 Enhancing of professional status by higher level of digital skills Figure 23 Care recipients use of digital devices and/or applications Figure 24 Appreciate additional services supported by digital/ict skills Figure 25 Likeliness of using simple digital devices for keeping medication schedule or planning meetings Figure 26 Likeliness of using simple digital devices for communication with family and friends

287 INTRODUCTION The survey was conducted between September and November An online questionnaire was developed with the support of Lime Survey, an open source programme, and sent per Link to the participating organisations. The organisations participating in this task were (country and number of questionnaires listed in brackets): _ EOS (Romania, 42) _ IFEF (France, 55) _ IRS (Italy, 19) _ LIKTA (Latvia, 19) _ LSA (Latvia, 21) Figure 1 Questionnaires received by partners (in total numbers) IFEF IRS LIKTA LSA EOS Source: Survey conducted by 3s, September November 2012, n=156 At the beginning of the survey, the intention was to also obtain questionnaires from the Swedish partner. However, as they withdrew their participation during the survey period, no questionnaires were received from Sweden. In total, 156 questionnaires were analysed for the following report. Some partners reported great difficulties in finding care workers/caregivers that would answer the questionnaire. For example, in Italy most of the care workers/caregivers are working illegally and they do not want to be part of a survey, even though the survey was anonymous; but still they were frightened that somehow they might be exposed to the authorities, if participating. 287

288 On the contrary, in France most of the people participating are organised care workers/caregivers that work under completely different conditions than those illegally working in Italy. In Latvia most of the people working as care workers/caregivers are of Latvian origin as the country has difficulties attracting people from other countries to come and work in Latvia at the moment (even in the care sector, where a high proportion of migrant workers was expected). Also in Romania people working as care workers/ caregivers are of Romanian origin, here a similar situation as in Latvia exists. Altogether the sample was very divers, bringing together experienced care workers/ caregivers and people who just attend a course in order to be able to work as care workers/caregivers; people working illegally, organised care workers/caregivers, and few relatives and family members who all work under different conditions. As only 156 questionnaires were collected and most questions had many categories (e.g. 1-10), it is not possible to further differentiate the answers received by variables such as respondent s job, country of origin or overall level of digital/ict skills; the numbers within each cell would be too low for further quantitatively analysing the data. 288

289 RESULTS GENERAL INFORMATION ON RESPONDENTS 44% of respondents work as freelance care workers/caregivers (hired directly by the care receiver), 33% are organised care workers/caregivers (hired by an agency, hospital, social office etc.), 9% are would-be freelance care workers attending courses for care, 7% are relatives or family members, 3% work at intermediary employment services between family and carers (e.g. an agency hiring caregivers/care workers), and 2% are social workers. Figure 2 Respondent s job freelance care worker/caregiver (hired directly by the client) organised care worker/caregiver (hired by an agency, hospital, social office, would-be freelance care worker attending a course for care relative/family member intermediary employment service between families and carers social worker Source: Survey conducted by 3s, September November 2012, n=

290 With regard to the level of education of respondents: 3% have ISCED 1 (Primary education or first stage of basic education), 24% have ISCED 2 (Lower secondary education or second stage of basic education), 36% have ISCED 3 (Upper secondary education), 20% have ISCED 4 (Post-secondary non-tertiary education or Short-cycle tertiary education), 16% have ISCED 5 (Bachelor or equivalent or Master or equivalent), and 1% has ISCED 6 (Doctoral or equivalent). Figure 3 Respondent s level of education ISCED 1 ISCED 2 ISCED 3 ISCED 4 ISCED 5 ISCED 6 1 Source: Survey conducted by 3s, September November 2012, n=

291 25% of all respondents have up to 2 years experience in care work, and another 25% have between 2.5 and 5 years of experience. 22% of respondents have between 6 and 9.5 years of work experience, and 18% have more than 10 years. Figure 4 Respondent s years of experience in care work up to 2 years 2.5 to 5 years 6 to 9.5 years more than 10 years Source: Survey conducted by 3s, September November 2012, n=

292 The respondent s country of origin is most often their country of residence, which is surprising as more mobility was expected in the care sector. 31% of respondents are from France, 29% from Romania, 26% from Latvia, 3% from Italy, 2% from Poland, and 1% from Portugal and the Philippines, respectively. 8% of respondents declined to answer this question. As most of the questionnaires were collected in France, the majority of respondents country of origin is France. Figure 5 Respondent s country of origin France 31 Romania 29 Latvia 26 no answer 8 Italy 3 Poland Portugal 1 2 Philippines Source: Survey conducted by 3s, September November 2012, n=152 As the number of respondents is too small to further differentiate the following answers by the country of origin of the respondents, the following sections will present the overall estimations of all respondents. 292

293 INFORMATION ON RESPONDENTS DIGITAL SKILLS AND COMPETENCES Firstly, respondents were asked to estimate their overall level of digital/ict skills on a scale from 1 to 10: The majority (50%) rated their skills between 6 and 8. 44% rated their skills as below average (1-5), 12% of total respondents said that they had no digital/ict skills at all. Only 1% rated their digital/ict skills at expert level. Figure 6 Overall level of digital/ict skills no skills at all top expert skills 5 1 Source: Survey conducted by 3s, September November 2012, n=

294 Secondly, the respondents estimated their level of skills in management (organisation of messages and contacts sending, receiving, searching, sorting, grouping, indexing; attachments; security). Here 60% of respondents rated their skills above average (6-10), with 9% of the total number of respondents rating themselves as having top expert skills. 15% indicated they have no management skills at all. Figure 7 Skills in management no skills at all top expert skills Source: Survey conducted by 3s, September November 2012, n=

295 With regard to the estimation of their level of skills in working with text processors (e.g. Word) 20% of the respondents answered that they had no skills at all. 51% rated their skills below the average, 49% above it. Figure 8 Skills in working with text processors no skills at all top expert skills Source: Survey conducted by 3s, September November 2012, n=

296 Responding to questions about their level of skill in working with spreadsheet processors (e.g. Excel), 35% of all respondents estimated their skills as non-existent (no skills at all), and only 35% rated their skills above average (6-10). Figure 9 Skills in working with spreadsheet processors no skills at all top expert skills Source: Survey conducted by 3s, September November 2012, n=

297 31% of the respondents estimated that when it came to working with presentation software (e.g. PowerPoint), that they had no skills at all. Only 30% of respondents rated their level of skill as above average (6-10). Figure 10 Skills in working with presentation software no skills at all top expert skills Source: Survey conducted by 3s, September November 2012, n=

298 When it comes to searching and using information on the Internet (finding relevant information sources, evaluating information, orientation in web pages, uploading and downloading files) 71% of the respondents rated their skill level as above average (6-10), and only 13% indicated that they had no skills in searching and using information on the Internet at all. Figure 11 Skills in searching and using information on the Internet no skills at all top expert skills Source: Survey conducted by 3s, September November 2012, n=

299 When asked how frequently the respondents use online communication tools other than s, e.g. Skype or ICQ, 28% of respondents answered never, but 13% replied that they use it constantly. 60% estimated their frequency of using online communication tools less than average (1-5), 40% above average. Figure 12 Frequency of using online communication tools Source: Survey conducted by 3s, September November 2012, n=

300 29% of respondents never use social networks, such as Facebook, Twitter, Google+, LinkedIn. 55% rated their use of these tools as below average (1-5), but 35% rated their frequency of use as very high (8-10). Figure 13 Frequency of using social networks Source: Survey conducted by 3s, September November 2012, n=

301 28% of all respondents never work with digital media (downloading, uploading, creating and editing of photos, videos, music files). 67% rated their use of this as below average (1-5), 33% as above average (6-10). Figure 14 Frequency of working with digital media Source: Survey conducted by 3s, September November 2012, n=

302 With regard to the use of smart devices such as smart phones (e.g. iphone, HTC, Blackberry, Samsung Galaxy, etc.) and/or tablets (ipad, Amazon Kindle, Google Nexus, etc.), 49% indicated that they never make use of them. Only 27% rated their usage as above average (6-10). Figure 15 Frequency of using smart phones and/or tablets Source: Survey conducted by 3s, September November 2012, n=

303 DIGITAL SKILLS AND TECHNOLOGY IN CARE WORK In response to the question In connection with your job, which of the following devices do you use? 88% mentioned traditional mobile phones, 50% computers, 34% digital cameras, 15% smart phones and/or tablets, and 1% digital projectors. Figure 16 Use of devices (multiple answers allowed) traditional mobile telephone 88 computer 50 digital camera 34 smart phone and/or tablet 15 digital projector Source: Survey conducted by 3s, September November 2012, n=156 (281 answers) 303

304 In relation to the use of ICT applications in the performance of their jobs, 75% of respondents use Internet search engines, 70% use clients, 53% text processors, 39% social networks, such as Facebook, Twitter, Google+, LinkedIn, etc, 28% use Skype, ICQ or other online communication software, 24% photo, video or music editing software, 20% spreadsheet processors, 15% presentation software. 14% of respondents use no applications at all in connection with their job. Figure 17 Usage of applications (multiple answers allowed) Internet search engines (Google, client text processor social networks (Facebook, Twitter, Skype, ICQ or other online photo, video or music editing software spreadsheet processor presentation software none Source: Survey conducted by 3s, September November 2012, n=156 (352 answers) 304

305 Answering on the importance of digital skills and the level of digital skills in the effective performance of their jobs, 27% of respondents stated that they were not at all relevant. 18% indicated they were negligibly important, 34% fairly important, 14% very important and 7% do not know/are not sure. Figure 18 To perform your job well, your level of digital skills is: not relevant at all negligible fairly important very important don't know/not sure Source: Survey conducted by 3s, September November 2012, n=

306 30% of the respondents stated that there are no tasks or activities that could be undertaken more effectively if supported by the use of digital technology/ict. 11% answered that there are few tasks that could be improved by digital technology/ict, 15% stated there are some tasks, 13% stated there are many tasks, and 31% do not know / are not sure and were therefore not able to answer this question. Figure 19 Tasks that could be carried out better if supported by digital technology/ict no tasks few tasks some tasks many tasks don't know/not sure Source: Survey conducted by 3s, September November 2012, n=155 When asked in more detail about which tasks could be supported by digital technology/ict, those respondents who answered few tasks, some tasks, many tasks mostly identified organising/planning/reporting activities, contacts with doctors and families, and obtaining information on health issues from the Internet (for more detailed information see Annex 4.1). 306

307 16% of the respondents stated that there are no opportunities to learn about and receive training in digital skills related to their job (courses, classes), 26% said there are few possibilities, 25% some possibilities, 8% many possibilities, and 25% do not know / are not sure. Figure 20 Opportunities to learn and train digital skills no possibilities few possibilities some possibilities many possibilities don't know/not sure Source: Survey conducted by 3s, September November 2012, n=

308 7% of respondents stated they are not interested at all in attending a course or learning programme focused on enhancing digital skills related to their job, 11% are probably not interested, 34% are fairly interested, 34% are very interested, 14% do not know / are not sure. Figure 21 Interest to learn digital skills not interested at all probably not interested fairly interested very interested don't know/not sure Source: Survey conducted by 3s, September November 2012, n=

309 11% of respondents think that a higher level of digital skills will have no impact on their professional status and chances on the care work labour market, 22% stated it would probably not have any effect. However, 22% thought it could have a fair impact, and 26% believe it could have a significant impact. 19% do not know / are not sure how to answer this question. Figure 22 Enhancing of professional status by higher level of digital skills not at all probably not fairly so very much so don't know/not sure Source: Survey conducted by 3s, September November 2012, n=156 Those people who answered fairly so or very much so were asked to briefly describe which digital skills could be an advantage in their field of work. The most common answers were: Advanced internet navigation skills, spreadsheets skills, text editing/processing skills (spreadsheet and text processing also for documenting their own work); better research skills to find relevant information on Internet (for more detailed information see Annex 4.2). 309

310 ASSESSMENT OF CARE RECIPIENTS NEEDS 40% of the respondents stated that their care recipients never use digital devices and/or applications of their own, 17% answered that they rarely do. 15% indicated that their care recipients use digital devices occasionally, 8% that they do so often, and only 1% that they do so very often. 19% of respondents do not know / are not sure if their care recipients use digital devices at all. Figure 23 Care recipients use of digital devices and/or applications never rarely occasionally often very often don't know/not sure Source: Survey conducted by 3s, September November 2012, n=155 If the respondents answered rarely, occasionally, often or very often they were asked to briefly name digital devices and/or applications their care recipients use. The most common answers were: Traditional mobile phones; Smart phones; Computers; Internet, Google, Facebook, More detailed information on anwers to the open questions see below. 310

311 18% of the respondents stated that it is not at all likely that their care recipients would appreciate being provided with additional services supported by the respondent s skills in digital technology/ict. 24% answered it is unlikely they would appreciate it, 19% commented that their care recipients may possibly be interested, 13% that it is very likely they would appreciate it, and 17% do not know / are not sure if their care recipients would be interested. Figure 24 Appreciate additional services supported by digital/ict skills not at all unlikely possibly likely very likely don't know/not sure Source: Survey conducted by 3s, September November 2012, n=156 Those respondents answering possibly, likely, very likely were asked to briefly describe additional services based on their digital skills that their care recipients would appreciate. The most common answers were: Better and free communication services based on internet applications as Messenger, Skype, etc.; Communication, doctor's appointments, staying in contact with their family, other people ( Communication services in order to help them to keep in touch with relatives because most of them are living alone. ); Basic digital skills, basic Internet skills, being able to search the Internet (finding information). More detailed information on anwers to the open questions see below. 311

312 17% of respondents indicated that it is not at all likely that their care recipients would use simple digital devices that would help them organise daily activities such as keeping their medication schedule or planning meetings. 20% stated it is unlikely, 26% that is possible, 10% that it is likely, 12% that it is very likely, and 15% do not know / are not sure. Figure 25 Likeliness of using simple digital devices for keeping medication schedule or planning meetings not at all unlikely possibly likely very likely don't know/not sure Source: Survey conducted by 3s, September November 2012, n=

313 12% of the respondents declared that it is not at all likely that their care recipients would use simple digital devices that would help them communicate with family and friends (making phone calls, sending s and messages, engaging in social networks). 12% stated it is unlikely, 28% that it is possible, 17% that it is likely, 16% that it is very likely, and 14% do not know / are not sure. Figure 26 Likeliness of using simple digital devices for communication with family and friends not at all unlikely possibly likely very likely don't know/not sure Source: Survey conducted by 3s, September November 2012, n=

314 CONCLUSION Altogether the results showed that many care workers/caregivers lack digital/ict skills. They estimated their overall level of ICT/digital skills rather positive only 12% stated that they had no skills at all but if asked in more detail about specific programmes or applications it showed that they are not very experienced. For example for word or spreadsheet processors the overall estimation of the respondents on their own skills was rather low, although most of them name these skills as necessary for enhancing their professional status. At the same time their frequency of using different communication tools, social networks, digital media or smart phones and tablets is rather low. With regard to using devices or applications in a care working context 14% of all respondents stated that they do not use any applications at all. Besides this non-use of some care workers/caregivers, Internet search engines, clients, text processors, social networks, and online communication programmes are used very often. Mostly these applications are used to search for information on health topics, communicating with the care recipients friends and family, for organising, planning and reporting activities or for making appointments with doctors. A great majority of care workers/caregivers (68%) are fairly or very interested to attend a course or learning programme focused on enhancing digital skills related to their job. So there is a high need to receive additional training that has not been fulfilled by appropriate programmes yet. The care recipients overall needs with regard to digital/ict skills were estimated rather low by the care workers/caregivers. If asked more precisely (for example if the care recipients might be interested to use simple digital devices to communicate with their family and friends), the overall estimation is higher than if general questions about the appreciation of additional services supported by digital/ict skills are asked. Therefore, care recipients might be interested in digital devices if they can use them easily and if they see their benefits, e.g. staying in contact with other people, finding information about their diseases etc. Overall, the information collected on digital/ict skills that the care workers/ caregivers would be interested to learn, brings together very basic skills like better Internet search skills to find relevant information, spreadsheets skills, text editing and processing skills (for documenting their own work). More specific skills were only rarely mentioned. Therefore, programmes and courses for learning basic digital/ict skills with a clear connection to care work (e.g. showing how care workers/caregivers and care recipients can benefit from them) would be highly appreciated. 314

315 OPEN QUESTIONS ARE THERE TASKS OR ACTIVITIES IN YOUR JOB THAT COULD BE CARRIED OUT BETTER IF SUPPORTED BY USAGE OF DIGITAL TECHNOLOGY/ICT? If the respondents answered that there were few, some or many tasks, the following tasks were listed: _ Communication over Skype - checking the condition of care receiver, electronic prescription of medicine _ reporting, making care work plans for the next week, communication with other care workers _ Planning care schedule, reporting, searching for advice on care work online, communication with colleagues _ Security button administration _ reporting results, searching for care work tips and advice, communication with management _ Connection with colleagues, reporting _ Contacting doctor _ Checking out information, making photos of patient, treatment tools _ Search for information on the Internet _ Communication, training _ Find information on the Internet about patients illness, new medicine _ Communication with the care receiver (via Internet), search for care information _ Providing my care person with information, having Internet communication with care person, finding out the right prescriptions _ planning daily activities using applications such as Word or Excel. _ activities related to the recipient's wishes/needs to know more about different diseases, treatments, treatment places. _ completing the daily report regarding the care workers work, planning their activities by creating a calendar _ reporting task, collecting information in my fieldwork _ organising better daily tasks using Internet for paying the bills, making online appointments to the doctor and treatment for the cared beneficiaries _ the tasks related to databases in order to gather the information from the care-workers, also the Internet skills to be able to search information and to be in touch with all the new things that appear in the care work sector. _ tasks regarding the collection of information from the internet - information needed by the care-workers when they are in the working field and they don't know certain things about care recipients treatment or other things. _ payment of bills - prescription of medicaments - patient's diary _ Get information on health issues _ Planning schedule, organisation of lunches and activities, accounts, management of available places, and many other things! _ Answering mail and planning schedule 315

316 _ Organisation of lunches, contacts with family and doctors, education _ finding new songs and pictures, sending photos to parents by _ Spreadsheets _ In order to help children working with computers _ Sharing information with families, managing schedule and salary with families, searching for new employers and new tools for children, editing pictures, training, etc. _ Fill and amend employment contracts, quicker communication with child care authorities _ Downloading video clips, recording lists of tasks for the helper or medical advice, easy-tohandle cell phone for persons with disabilities or memory troubles _ Online orders, administrative procedures, online recipes, doctors' contact details, etc. _ Online training _ Creating databases with all the persons that are working in the domiciliary care sector in order to find more people working in this field. _ maybe task related to better time management: tables in Excel to keep an evidence with the things that need to be done during the day. _ I use ICT in all my daily tasks. _ Tasks whereby I have to inform myself about treatments and new procedures appeared in the medical field. Most of them (my clients) are very sick and the information is a very important aspect in this field. _ Planning activities and those related to appointments that need to be done for the care recipients. _ Task regarding the list for shopping, daily report activities, requests for different institutions for the care recipients, evidence with the activities that weren't carried out. 316

317 WOULD A HIGHER LEVEL OF DIGITAL SKILLS ENHANCE YOUR PROFESSIONAL STATUS AND INCREASE YOUR CHANCES ON THE CARE LABOUR MARKET? If the respondents answered fairly so or very much so the digital skills that could be an advantage in the field, that were listed the most, were: Skills to search the internet, skills related to text processors, spreadsheets, presentations and databases. Besides this, also website development, photo processing, using online applications, using internet communication tools, smart-phones and tablet PCs, social networks _ I am interested in learning new things, including digital skills _ Working with a computer will help to prepare my documentation and reports _ Search of information on internet, internet communication tools _ skills to search on the internet for necessary information. _ skills related to the use of online applications _ the skills related to text processors, presentations and database. Also internet navigation skills are very important. _ those about creating databases. _ I would like to be able to use a computer _ Work _ Internet to learn more about certain subjects and communication tools to remain in touch with institutions relevant to home care _ Better access to information and better proficiency _ Possibly answering clients' needs _ Spreadsheets processor, photo editing software, accountancy programme, etc. _ s, appointments _ Better research skills to find relevant information on internet _ Website development _ Spreadsheets _ Excel for sharing schedule with families, word for trainings, ppt and photo edition programmes to prepare presentation material _ Apply for jobs in other sectors _ Relationships _ Social networks, word processing, photo edition programmes _ Computer literacy _ Online job offers, training _ Internet navigation, working with spreadsheets _ Skills related to the use of new devices as smart-phones, PC tablets. They are small devices that can be carried out easy all the time with you, so you are permanently connected to internet. _ maybe better excel skills. _ Internet navigation because we can identify the people working in the care sector, Advanced skills related to spreadsheets. _ digital skills related to Social networks: using social networks you can be in touch with other professionals and talk about common topics from domiciliary care sector. 317

318 _ Because I'm taking care of my mother I think that the skills that I have at this moment are sufficient in order to ensure a better care and also to help her to navigate on the internet and to find the things she is interested in. _ Better skills in using text processor, spreadsheets and presentation software. _ Advanced skills of working with spreadsheets. _ Advanced internet navigation skills, spreadsheets skills. _ I think that the most important skills are those related to internet navigation and they are an advantage in the field of work. Of course and the skills about text processing and presentations are very important. _ In home care work most important ICT skills are internet skills and those that can help the care worker to better organise his work: skills of text processing, low skills of using spreadsheets (to be able to make a table and easy operations as sorting and filtering, to introduce a formula). These are the skills that could be an advantage in the care work sector. _ Text processing skills and social networks. _ good knowledge of office package. skills to work with texts, tables, images, presentations and of course good skills of internet navigation. _ Especially those skills that are related to office applications: spreadsheets skills, processing text in word. Also to be able to use new devices. _ skills about text processing and maybe social networks to be always in touch all professionals in this area. it is important to know to write a text and to do electronic documents. _ Basic skills of computer operating as internet navigation, spreadsheets - especially tables, social networks. _ In the care work sector the most important skills that can be an advantage are those of editing text, completing tables, to navigate on the internet in order to find out all the news that appear in the care work sector. _ Basic digital skills such as writing texts, navigating on the internet, skills to use a smartphone so you can have access on the internet and when we are on the field. _ those that really are an advantage are internet skills and those related to internet communication. Today it is impossible to be able to perform well your tasks without them. _ Text editing skills for documents in the first place and internet navigation for looking up for the information and for completing applications online. _ Internet navigation skill, texts edition. _ Basic skills of computer use as Internet navigation, text editing, skills presentation.) 318

319 DO YOUR CLIENTS USE DIGITAL DEVICES AND/OR APPLICATIONS OF THEIR OWN? If the respondents answered rarely, occasionally, often or very often, they were asked to briefly name digital devices and/or applications their clients might use. _ Cell phones _ Computer _ Computer - Google, Yahoo, Facebook. _ Computer - Google, Yahoo, Messenger, Facebook. _ Computer - mostly for . _ Computer - this is used just by those who have in their family children and grandchildren that know how to use computer. Other devices used are traditional phone and mobile phone - the last one less. _ Computer, mobile phone _ Computer, Smartphone _ computer, traditional mobile phones _ Computer: Yahoo/Messenger, Facebook, Google-Phone _ s, Facebook _ Especially the phone. Mobile phone and traditional phone. _ Google _ Google, Yahoo mail, Yahoo messenger _ Internet _ Internet _ Internet _ Internet and _ Internet, mail, Facebook _ Internet, PPt, Excel _ Internet. _ Ipad 2, computer mobile phone, internet _ Mails _ mobile phone _ mobile phone _ mobile phone _ Mobile phone and computer _ mobile phone, computer _ Mobile phone, computer - with assistance only _ mobile phone, computer, internet _ Mobile phone, computer. _ Mobile phone, computer. _ Mobile phone, computer. _ Mobile phone, PC. _ Mobile phone. _ Mobile phone. _ Mobile phone. 319

320 _ Mobile phone. _ Mobile phones _ Mobile phones _ Mobile phones, computers _ Only 2 persons have access to the computer, the employer doesn't have the skills _ PC, mobile phone. _ Phone, computer. _ Photos, s, salary declarations, s, Skype _ Sending schedules _ Tax authorities' website _ Phone very often and computer - but just a part of them for the second one. _ Traditional phone in most of the cases. Traditional mobile phone _ Traditional phone and mobile phone. _ Traditional phone and rarely computer: the applications used are especially those of watching photos or listening to music. _ Traditional phone, mobile phone - very rarely. Computer is also used - but just by those that have children and nephews that are using such devices. _ Usually mobile phone. 320

321 HOW LIKELY IT IS THAT YOUR CLIENTS WOULD APPRECIATE YOU PROVIDING THEM WITH ADDITIONAL SERVICES SUPPORTED BY YOUR SKILLS IN DIGITAL TECHNOLOGY/ICT? If the respondents answer possibly, likely or very likely they were asked to briefly describe what additional services based on their digital skills would their clients appreciate. _ Additional services about better communication services and usage of digital devices. _ Additional services based on the use of digital devices. In this moment we don't have the opportunity to offer this service because of the lack of funds. _ Additional services related to computer use or other new digital devices. To offer them help in using new applications related to digital devices. _ Better and free communication services based on Internet applications as Messenger, Skype, etc. _ Better databases so the access of information related to domiciliary care sector to be more accessible. _ Children-related skills _ Communication services in order to help them to keep in touch with relatives because most of them are living alone. _ Communications _ Contacts with family, administrations and doctors _ Creating digital life books _ Does not answer _ Does not answer _ Does not answer _ Draft mails _ Films _ Help them to use digital devices. _ I don't know, in our country the services based on digital technologies are not very developed. _ I don't know. _ I don't really know, it depends by case to case. This will be relevant just when we will have the opportunity to offer this service. _ I think that services related to social networks. At this age elderly feel the need to be in touch with other people and social life is important for them. Even if my father lives with us, the need to be in touch with people his age and to share common activities is an important need. _ If we would have the opportunity, some of them would be happy to see how they can use digital devices as smart-phone or Internet tablet and us to offer them support in this aspect. _ I'm not sure that there exist additional services that they can appreciate. _ I'm not sure, I don't have the opportunity to provide such services at this moment. _ Improving digital skills would increase the quality of work and would lead to more time allocated to each beneficiary. This would be really appreciated by our clients, more time spent with them in order to realise and recreational activities. _ In my classes I try to see which are their interests and I work with them to acquire those skills they need in order to be able to do the things they wish to do online. They appreciate a lot the fact that we have patience and that they learn about things of interest for them. 321

322 _ Information services and social networks. _ Information services related to Internet navigation skills. _ Interactive communications, automatic messages, reminders _ Internet information, communications _ Internet payments _ It's hard to say in this moment, which are the digital skills that they would appreciate because I don't have advanced ICT skills. Additional services would require having permanently a device that can be used for the care recipients. _ It's hard to say which are additional services that they will appreciate. In this moment most of them don't use the digital devices because they can't afford to buy and also to pay a monthly subscription on Internet. We don't have portable devices to carry out with us and to offer the possibility to learn. _ Most of them I think that would appreciate the information services. They are always curious to know more about their disease, natural treatments and more about the medication they follow. _ Not sure, maybe more help in using social networks and Internet. _ Pay-checks _ Photo editing _ Searching online information, s with clients' families, photo edition programmes _ Security button ( to call for care worker ) _ Services related to provide new information of interest for seniors - information that can be obtained using the computer and internet. _ Spreadsheets, photo edition programmes _ The abilities related to the use of online applications in order to make appointments online, shopping online. _ The fact that we have the opportunity to make doctor appointments online, to look for the information they need regarding new lows that appear, and why not to work with them on the PC to read about things they love. _ The possibility to work with them more on the computer - most of them are interested in the latest applications but they are not able to work alone especially at the beginning. _ They would appreciate if we would have always a digital device to find immediately the answer to appointed questions that they have. _ They would appreciate services based on our internet skills because they are very eager to know as much information as possible about all kind of things. Because most of them are living alone also they feel the need for communication. _ Those related to Internet navigation - the possibility to offer them information about different topics of interest for them: treatment places, prospects of medicines, etc. _ Those skills that are related to Internet communication. This will motivate them to learn how to use application such as Messenger, Skype. _ Use digital support as an educative tool for children and parents; being able to provide clear and efficient spreadsheets and reports would be an asset _ Various Internet research _ We don't provide ICT services for our clients, so any services that we will provide for them will be welcomed. 322

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