Digitization in the care sector

Digitization – or digital technology – can be extremely useful to elderly people and care recipients in many areas of life, enabling them to largely go about their daily routines without depending on the assistance of others. Everyday risks can be minimized and social interaction is facilitated. Digitization also offers opportunities to improve healthcare and support family and professional carers.

Digital technology cannot completely replace the support and devotion offered by humans but it will become ever more important in the care sector. This is because it can help deal with the challenges posed by demographic change: the number of elderly people and people in need of care and support is set to steadily grow over the coming decades. Even today, it is clear that there will not be enough professional carers to cope with this situation.

Despite these advantages, the use of digital technologies can limit or violate the human rights of elderly people and people in need of care. As a result, the benefits of technology should be weighed up against the legal and ethical issues in each case. Consideration should also be given to the fact that digital technology will be increasingly able to learn autonomously and influence people’s decisions.

Many digital products for care purposes are still in the development and test stages. But even today, some are already able to provide significant support to elderly people and care recipients.

Digital technologies used in the care sector:

• Healthcare networking
• Apps and web applications
• Digital assistance systems and care aids
• Robot systems
• Video consultations and online training

Healthcare networking

The care sector is being gradually connected to the telematics infrastructure (TI) and therefore digitally networked with other players within the German healthcare system.

One of the things this means for care recipients is that it will in future be possible to store care documents in the electronic patient record (ePA), for example patient transfer documents (“Pflegeüberleitungsbögen”). Software manufacturers of e-care documentation are also working on making it possible to store ongoing care documentation in the ePA as well.

The networked status will enable outpatient care services and facilities to view released documents in the ePA, such as test results or the e-medication treatment plan – as well as to exchange messages and documents via a secure communication channel.

If the person in need of care approves general practitioners, specialist doctors or professional carers to view certain documents, cooperation improves even further as the professionals obtain quicker and more continual insights into the condition of the care recipient’s health and can tailor the medical treatment to the care.

Apps and web applications

Care apps and web applications on smartphones or computers can help care recipients better organize and manage their everyday life and care needs at home. Examples include exercises to reduce the risk of falls or personalized memory games for people with dementia. Apps also improve collaboration and communication between relatives and outpatient care services.

If an application is approved as a digital care application (DiPA), it is possible to apply for a grant for its use from the care insurance fund.

Digital assistance systems and care aids

Digital assistance systems and care aids can enable elderly people and people in need of care to remain in their own homes for longer. They assist them, for example, with everyday tasks and help them independently deal with illnesses or treatments. They are also able to monitor the behavior and health of elderly people in order to intervene in an emergency.

The home emergency call system is an example of a digital assistance system that has already been in use for years: help can easily be called on the spot by pressing an emergency button on the wrist. In recent years, this system has been further developed and tested. For example, sensors distributed throughout the home send a warning if they have not registered any movement for a prolonged period or if the refrigerator door has not been opened for a certain length of time.

Digital reminders and orientation aids help people retain their everyday independence. Examples include digital medication dispensers, GPS trackers, smoke detectors with a stove switch-off function or pressure mats that trigger a silent alarm if people with dementia leave their bed.

The consumer advice centers provide information about the conditions under which the costs of such products are covered by care and health insurance providers plus offer advice on how to apply for them.

Robot systems

Support from robot technology is still in the early stages in Germany but even today, there are assistance robots that can perform routine service tasks, such as supplying meals and medication. Therapy robots are increasingly being used for people with dementia to train mental and communication skills.

Video consultations and online training

People seeking advice should be able to make increasing use of digital consultations and training. For example, care advice (§ 7a of the Eleventh Book of the German Social Code, SGB XI) can be provided via video call on request.

In the case of specific questions relating to everyday care, care recipients and their relatives should in future be able to obtain rapid advice and guidance from professional carers via video calls known as teleconsultations. This will be tested in a pilot project from 2022.

Even today, many health and care insurance providers offer online training courses that provide practical care knowledge. The e-learning sessions are free for relatives and people who want to voluntarily perform care roles.

The topic of “digitization in the care sector” raises many ethical and legal questions. The UN Convention on the Rights of Persons with Disabilities (UN CRPD) stipulates that digital technology must be affordable and accessible so that all people can use it on an equal footing.

However, the use of technology can restrict or violate the human rights of elderly people and people in need of care.

Human rights

The following human rights may be restricted, for example:

• Digital technology enables people in need of care and assistance to largely go about their everyday routines in an independent manner. At the same time, excessive use of technology can isolate them in their home and contribute to loneliness. This can violate the right to be included in the community.
• Assistance systems that monitor the health and movement of people with mental disabilities provide safety. However, this technology can violate their privacy – and their right to decide who has access to what personal data (informational self-determination).
• The more digital technology is able to learn, i.e. to evaluate data and to derive suggestions for future behavior from it, the more it can influence decisions and reduce self-determination. People can have their choices limited and lose control over certain processes, for example.

Elderly people and care recipients have the right to determine how they live – and that includes declining digital support. All applications must be discussed and agreed with the person affected prior to their use. To do this, they need to be informed about or trained in the use of digital technologies so they can weigh up the risks and specific benefits of certain technologies.

On the other hand, digital technology can relieve physical and mental strain on family and professional carers: freedoms and simplifications are important for their own health.

Decision aids

The benefits of digital products therefore have to be weighed up against the legal and ethical issues in each case. This particularly applies when others are making decisions for elderly people or care recipients because they are no longer able to do so themselves.

Answering the following questions can make it easier to decide whether digital technology should be used:

• Is the digital support necessary and does it generate an otherwise unattainable benefit?
• Does the product help the person maintain self-determination and independence, or does it restrict freedoms and other human rights?
• Does the strain relieved from the family carer justify a possible restriction of the care recipient’s rights?

The German Institute for Human Rights (DIMR) provides an overview of the opportunities and risks of digitization in relation to elderly people’s rights.

The German Alzheimer’s Society (Deutsche Alzheimer Gesellschaft) provides further questions and considerations that can help when making decisions.

Not all digital products available on the market are recommended. In addition to ethical and legal considerations, products should also be assessed with regard to the following points, among others:

The application is simple and intuitive to use for elderly people and people in need of care.

The content of apps and web applications is tailored to the conditions in Germany, for example applications, legal matters, support services.

In particular, health data is fully protected. The software is updated regularly (at least once a year).

The patient information “Checklist for the use of
health apps” from the Action League for Patient Safety (Aktionsbündnis Patientensicherheit e.V.) offers criteria and recommendations for assessing the quality of apps.

Insured persons can also be assured that digital products meet certain standards if they are listed in the catalog of resources provided by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) or the DiPA or DiGA directory from the Federal Institute for Drugs and Medical Devices (BfArM). Only the digital products listed there can be reimbursed by health or care insurance providers – and only if the applicant also fulfills all other conditions.