Decision Making and Use of Remote Monitoring Technology in Low-Income Independent Living Residences

Passive monitoring systems installed in the homes of older adults have been proposed as a way to revolutionize home healthcare by enabling earlier detection and prevention of health events and delaying health related relocation; however, the processes and social implications are poorly understood, uptake is low, and these purported benefits have not been fully realized. This study combines data from 47 interviews and system alert records to understand lived experiences with the technology of ethnically diverse older adults, family members and staff of low-income independent living residences. A sensor-based passive monitoring system has been on offer to residents as a voluntary subsidized intervention for six years. This study examines the 1) processes involved in decision making about adoption and discontinuation, 2) the procedures of using the technology, 3) experiences with and articulations of privacy, and 4) how participants assess the usefulness of this passive monitoring system. The three papers that comprise this dissertation are outlined below. They provide complementary presentations of my analyses of the most significant findings that correspond to the study's primary research questions. The three papers examine the following:/n1) Resistance on a spectrum: Shaking the `pro-adoption bias' in studies of passive monitoring and aging./nGiven the low uptake of passive monitoring, the concerns, needs and perspectives of users, nonusers and former users is a rich area for inquiry. In this first paper, I present the range of ways older adults relate to passive monitoring, including experiences of adoption, nonadoption, discontinuation and creative `misuse.' The priorities of users (e.g., safety, privacy, control, contact) are shown to be more diverse and multi-faceted than those of the housing organization and family members (e.g., safety, efficiency). The tension between needs, desires, and the daily lives of older adults and the technological solutions offered them is made visible by their active appropriation of and resistance to them. The broad spectrum of resident resistance challenges the dominant image of passive subjects of a passive monitoring system that is designed with little room for resistance or creative use, exposing the active and meaningful qualities of older adults' decisions and practices./n2) Breathing room in monitored space: Opportunities for privacy in boundary management./nWhile scholars have been quick to note that privacy intrusion is a primary issue to be explored with the use of passive monitoring, academic writing about how privacy is impacted has be limited by our conceptual tools. Information privacy has been the focus of study to the exclusion of personal privacy. In this paper, I examine the ways in which privacy in passive monitoring practices is articulated by participants. These findings reveal where breathing room is eclipsed and where changes to passive monitoring design and practice could create opportunities for residents to manage their own boundaries./n3) Calculating risk and the management of living: Social workers in a bind./nIn the final paper I describe the practices and rationalities formed around the selling of the passive monitoring technology to independent living residents who were largely uninterested. Data reveal that the pressure exerted on social workers by their supervisors trickled down into negotiations with residents over adoption. These findings highlight the importance of understanding and respecting older adults' reasons for nonuse as well as relieving frontline staff from having to navigate untenable paradigms in the name of independent living technology.

Advisor: Scharlach, Andrew E