Enacting telecare 'at scale' : A study of care, cuts and boundary making practices

Atkinson, Theresa and Mort, Maggie and Roberts, Celia (2020) Enacting telecare 'at scale' : A study of care, cuts and boundary making practices. PhD thesis, Lancaster University.

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Abstract

This study was set in the context of an English local authority’s ambition to expand telecare use at a time when resources were rationed, demographic demands were rising and technologies of care, despite evidential uncertainties, were increasingly seen as potential care ‘solutions’. My ethnographic approach was multi-sited, had depth as well as breadth, and involved observation of installations, document analysis, in-depth interviewing, shadowing care assessments and the work of control centre staff, as well as examining call data. Telecare was provided ‘at scale’ and celebrated as an accomplishment, but telecare and scale are considered here as multiple, only coming into being through complex material-discursive practices and multifaceted entanglements of people, feelings and things. My thesis disturbs and unsettles the celebratory account, highlighting hidden frictions and tensions that emerged along the way. Although I found collaboration and co-operation for some, ‘person-centred-tele-care’ was always in the making, and for some it was hardly made at all. Telecare’s intelligent, automatic fall detection systems, were also not that stable nor predictable, failing to concede fully to the social and technological ideal with older people’s personal care needs not always addressed as envisaged in the care planning process. I draw on Barad’s agential realist ideas, particularly her notion of ‘agential cuts’ and boundary making practices, attending not only to matters of fact, matters of concern, matters of care, but also to matters of ethics and consequence. The focus on at-scale provision, I argue, obscures telecare’s complexities and contingencies and creates more scale, more uncertainty and more indeterminacy. Telecare at- scale provision also diverts attention, ambition and aspiration away from more creative human and non-human centred care alternatives. In my thesis I try to re-imagine a future for care, for older people, particularly for those living alone, with or without the use of telecare.