Technology-enabled legal service delivery for older adults: what can law learn from Telehealth? Findings from an international review of literature.

• Jurisdiction: Australia
• Author: Ries, Nola M.
• Date: 01 January 2016

I INTRODUCTION

Australia, like many industrialised countries, is experiencing two major, unprecedented social phenomena: the ageing of the population and rapid advances in information and communication technologies (ICTs). Both have implications for legal service delivery. Much has been written on how the ubiquity of web-connected computers and mobile devices will transform legal service delivery, vastly expanding ways for lawyers to connect with people who need legal help, extending the reach of not for profit legal assistance providers, and making legal proceedings more accessible and convenient. (1)

But what promise does technology hold for improving access to legal services for older adults in order to help meet their particular needs? (2) Technology is already transforming health service delivery with telehealth initiatives that use ICTs to connect health professionals with older adults who would otherwise face barriers in accessing care. Similar to telehealth, lawyers can use video or webconferencing technology to deliver legal help, including one-to-one consultations and community legal education targeted to the needs of older people.

Our aim in this paper is to identify lessons learned from telehealth that can inform the development of 'telelaw', technology-enabled access to legal assistance. We focus particularly on the use of technology to help surmount the barriers for older people due to factors such as mobility limitations, social isolation, geographic isolation, and socio-economic disadvantage. First, we discuss the legal needs of older adults and elaborate on the value for the legal sector in looking to telehealth and its use of new technologies to meet the needs of underserved populations. Based on a literature review that is international in scope, we next present research findings on the uptake of and satisfaction with video or webconferenced telehealth services. This analysis challenges assumptions that may exist, for example, that older people resist the use of technology or that technology-enabled services are inferior to in-person services. We identify key lessons from telehealth that can be applied to inform the design, delivery and evaluation of telelaw services and offer some practical suggestions for facilitating access to telelaw services for older clients. Finally, we emphasise the importance of careful evaluation of telelaw projects to develop the evidence base in this emerging field.

The Legal Needs of Older Adults

Australia's population is ageing with large increases anticipated over the next fifty years in the number of older Australians. (3) It has been reported that "[a]lthough most types of legal problems are less prevalent among older people [including legal problems related to criminal activity, rental housing, credit and debt, child and family disputes], some types of legal problems are relatively common in this age group. In particular, past research has found that wills, estates and power of attorney issues are common in the older age groups." (4) Statistics from Law Access New South Wales, a free statewide telephone service that offers legal information and referrals, show a significant proportion of legal matters related to elder law. (5) Likewise, the Seniors Rights Service, a community legal centre that provides advocacy, legal advice and education to older people, reports that powers of attorney and wills and estates represent the greatest portion of issues recently raised by clients, followed by guardianship and financial elder abuse queries. (6) Current State and Commonwealth governmental inquiries highlight the serious issues of abuse, especially financial abuse, experienced by older Australians and the need for legal services to help deal with these problems. (7)

Older adults may experience barriers in accessing legal services. (8) They may not recognise that a problem is a legal issue capable of legal resolution (9) and, attitudinally, "might be more likely to 'put up with problems' as part of life, have higher tolerance levels and a greater degree of stoicism." (10) Some older people may perceive that lawyers are disinterested in their legal concerns (11) and there may be a "sense of fear, mistrust, uncertainty and ambivalence among older people towards accessing legal advice." (12)

Residents in rural, regional and remote (RRR) areas, which tend on average to be older than urban populations, face unique problems. Research consistently identifies this population as having particular vulnerability to legal problems, a lack of capacity to resolve legal problems on their own and limited access to professional legal services. (13) For older adults, legal problems can arise in matters that include

the complexity of assets held by families resident in rural areas such as farming properties; lack of access to services that may assist with asset management arrangements and responses to situations where elder abuse is occurring or expended; and the dynamics involved in reporting or disclosing elder abuse in rural communities, where shame and concern to protect the family name potentially play an inhibiting role. (14) More remote areas of Australia have the highest ratio of residents to solicitors, those solicitors are more likely to be young and inexperienced, and legal aid services and community legal centres may not cover all areas of law that are particularly relevant for older persons. (15) Limited access to transport in rural and remote areas together with mobility restrictions for some older people compound the barriers they face in seeking legal assistance in a timely way.

Sage-Jacobson asserts that older adults experience "a distinct disadvantage in access to justice.

... the evidence does show that older people face particularly strong barriers to gaining legal assistance and achieving satisfactory resolution compared to other Australians." (16) So how can technology help?

Brescia and colleagues contend that technology-driven innovations in legal service delivery will develop from those serving disadvantaged clients who do not have the resources to access traditional law firms:

True disruption is likely to come from those serving the "lower end" of the market: the solo practitioners, legal services lawyers, and "low bono" providers of legal services. It is innovation in these corners of the market where pathbreaking disruption will take place, mostly out of necessity. What is more, it is the low-end of the market that is actually quite robust--that is, there is a desperate need for legal services, just an inability to pay for them. If disruption is indeed coming to the legal services market, and few can doubt that it is, technological innovation, one of the main drivers of this disruption, can serve to widen access to justice in communities desperate for legal assistance--low- to moderate-income communities, the working poor, and the middle class. (17) To this list, we add older adults who may face multiple barriers in accessing professional legal assistance.

Looking to Telehealth

In our view, the legal profession can learn much from the field of telehealth in its efforts to use new technologies to meet the needs of underserved populations. Telehealth refers to the use of ICTs

to deliver health services and transmit health information over both long and short distances. It is about transmitting voice, data, images and information rather than moving care recipients, health professionals or educators. It encompasses diagnosis, treatment, preventive (educational) and curative aspects of healthcare services and typically involves care recipient(s), care providers or educators in the provision of these services directed to the care recipient. (18) A recent systematic literature review concludes that "[t]he best application for telemedicine seems to be for frail, elderly or remote patients" (19) as they face the greatest barriers in attending in-person professional consultations. Telehealth initiatives are underway around the world and a substantial body of research reports findings from the implementation and evaluation of these projects. The value of looking to literature on telehealth is underscored by the paucity of evidence evaluating programs that deliver technology-enabled legal assistance. In 2011, the Law and Justice Foundation of New South Wales reported on an extensive search for literature on videoconferencing to provide legal outreach and found "virtually no research reports which have specifically evaluated the effectiveness of video conferencing for the provision of legal assistance." (20) Legal aid organisations and community legal centres are undertaking video or webconferencing legal assistance pilot projects in various parts of Australia, however, evaluation results are limited or not yet produced. (21)

In 2012, the federal government funded several telelaw projects as part of its National Broadband Network Regional Legal Assistance Program and a summary of experiences is available as a conference paper. (22)

Literature Review Method

We searched for English-language literature in health, legal and multidisciplinary databases. (23) Our search terms were constructed to identify articles dealing with technology-enabled health and legal service delivery targeted at people aged 60 years and older. (24) We included studies involving video conferencing, web conferencing, Skype or other Internet-based applications that support interactive, synchronous audio-visual consultations and allow participants to read documents together and to see and react to non-verbal communication cues. Our legal literature searches returned a small number of articles discussing older adults' attitudes and behaviours in relation to using the Internet to search for legal information. (25) While not directly relevant to our research question, these articles provided useful contextual information. In health literature, we excluded studies on 'smart technology' used...