While many of these technologies can be produced and sold at reasonable or even inexpensive prices, others, such as robotics and smart home components, are much more costly. For patients the cost of these products can be a major impediment to their purchase and use, especially given that insurance does not always provide adequate coverage for them.
In addition to cost, another significant barrier to the broader diffusion of these technologies is a lack of product information. Older adults frequently do not have adequate information on the basic use of specific devices, or the suitability of these devices to their specific needs (Hoenig et al., 2002). Furthermore, patients often lack information about product quality and performance. More technical assessments are needed to help patients determine the effectiveness of various assistive technologies.
The IOM report The Future of Disability in America also noted that the financial incentives for developing better assistive technologies and bringing them to market are currently very weak (IOM, 2007). The report concluded that this was a persistent problem and recommended a number of countermeasures. Specifically, the report called upon policy makers to revise coverage criteria so that the criteria take into account the contribution of a technology to an individual’s overall independence, including the individual’s participation in the workforce and the community. The report also recommended that policy makers eliminate or modify Medicare’s requirement of “in-home use” with respect to coverage of durable medical equipment and that they investigate new approaches for supplying covered technologies, as well as providing timely and appropriate repairs.
Recommendation 6-1: Federal agencies (including the Department of Labor and the Department of Health and Human Services) should provide support for the development and promulgation of technological advancements that could enhance an individual’s capacity to provide care for older adults. This includes the use of activity-of-daily-living (ADL) technologies and health information technologies, including remote technologies, that increase the efficiency and safety of care and caregiving.
In addition to testing the use of health-information technology to improve provider communication and promote interdisciplinary care (as described in Chapter 3), research and demonstrations also need to focus on the application of assistive technologies. These demonstrations need to assess the effectiveness of these technologies in promoting functional independence and in easing the physical strain on, and the need for, direct-care workers and informal caregivers.