Recent funding programmes supporting research and development in telecare have argued for a shift in perspective from a technology-driven approach to one that is needs-led. While this is in the interests of both users and technologists, achieving this goal is not straightforward. This paper outlines some of the conceptual, methodological and practical problems that potentially constrain a needs-led approach and illustrates the emergent issues with a case study of the development of an intelligent home monitoring system to support the independent living of older people. The research indicates clear differences between users and technologists in the way problems, needs and requirements are understood and defined. This in turn has consequences for the way assistive technologies are developed and implemented.