The futuristic technologies that older people might have read about in their youth are close to reality and might just help many of them live independently for longer. Bronagh Miskelly and Andrew Mickel consider the promises of telecare and the barriers to implementation
Robots, domestic appliances that could think for themselves, voice activated lights, wireless communicators – all 20th century sci-fi images of what life would be now. These are the sorts of images that our now elderly population grew up with and, for them at least, much of it is becoming a reality.
Elderly people will increasingly be able to take up the choice of remaining at home if they have access to some of the newer telecare and assistive technologies. These could range from smart pill boxes that issue the right dose at the right time and work out when a repeat prescription is needed, to zimmer frames that provide advice on getting about, as well as a range of sensors and monitors.
It could also mean powered exoskeletons that help the wearers bend or stand allowing them to maintain hobbies such as gardening. Or even a robot vacuum cleaner allowing someone to deal with house work. On the other hand some are simpler technologies such as lights that switch on automatically.
To some, telecare is still centred on the idea of the emergency button which those in danger of falls wear as pendants. Meanwhile telehealth might include blood pressure monitors worn at home that can be connected to a computer. But developments are bringing together these two strands along with some consumer technologies to create a more complete system of support.
The 50-year-old emergency button technology is only useful if the wearer is conscious after an accident, whereas motion sensors that show whether a person has changed rooms or if they have been out of their bed for a long time during the night.
But is being up for a long time at night an indicator of an emergency in itself? The latest development work in this area involves creating ways for different assistive technologies to communicate or use standard ways sending information to monitoring systems.
This will mean that, through wireless technology, it could be possible to see that the lights haven’t been switched on in certain rooms for a period of time and that pills haven’t been taken – both scenarios that would trigger an emergency.
Equally, while the bed sensor sends a signal that someone has been out of bed for a while the kitchen lights and the smart pressure-sensing coffee table gives evidence that they are having a cup of tea.
Although this second scenario doesn’t suggest an emergency, it could trigger a message for a carer or a medical professional to telephone the service user the next morning to ask how they are sleeping.
These developments will change how we look at telecare. They will offer a greater range of supports which could offer solutions for personalised care and allow people to remain in their homes with less obvious interference. And they offer reassurance to families who are often geographically distant.
The vision of science could allow people to enjoy their old ways of life.
Barriers to change
For its advocates, telecare should be treated as another item in the toolbox to help people live independently, while helping to save money. For its detractors, its implementation is about cost-cutting, replacing human contact rather than complementing it.
Attitudes, inefficient structures, inappropriate prescriptions, inadequate training and poor response services are all significant barriers to implementation, as is finance.
An £80m preventive technology grant for local authorities in England was neither ring-fenced nor replaced when it finished this year. Even central government has failed to take telecare into mainstream services.
Take the dementia strategy, released in February. It said that telecare should be considered “as the evidence emerges” and specifically said it couldn’t make a general recommendation about its use at that time.
This is despite case studies showing that people with dementia can be helped to remain at home for longer, rather than go into residential care, if telecare products are fitted. These can range from lights that automatically switch on when a person enters a room, a plug that releases water if the bath overfills and a sensor that alerts a carer if someone leaves a room in the middle of the night.
Making it happen
Overcoming the barriers must start with a fundamental mindshift, says Kevin Doughty, deputy director of the Joseph Rowntree Foundation Centre for Usable Home Technologies at the University of York.
He emphasised the point during his talk at the Association of Directors of Adult Social Servicese spring seminar: 65%of the world’s stairlifts are made or bought in Britain. Why? “Because we’re the only country that keeps building stairs for older people!”
That is no small task: the hearts and minds of service commissioners, practitionersand service users must be won, and suppliers must meet their needs.
In England attempts are being made to persuade service commissioners of the benefits telecare can bring. In a bid to build up an evidence base, the Department of Health has funded the Whole Systems Demonstrators Programme, which is testing out both telecare and telehealth in 12 pilot sites, covering 6,000 people.
Just as evidence can be used to persuade commissioners, experience can help staff and service users overcome the fear that sensors will replace people.
“Once they are made aware of what telecare can do for them, once people have used the services, then it can be life advancing, says Caroline Bernard, policy and communications manager for older people’s charity Counsel and Care.
“It’s about showing it to people and letting them make an informed choice.”
Meanwhile, Scotland has made more rapid progress with telecare, thanks to a targeted use of money. The 32 local health and social care partnerships had to submit plans to a central body, the Joint Improvement Team, before accessing funds.
The use of targets has made for effective results, despite there being a similar cost outlay to that in England: savings totalled more than £11m in the first year alone, including 61,993 care home bed days saved. In total, it is estimated that for every pound spent, the scheme saved five more, while 93% of recipients felt safer.
Targets are useful for getting telecare off the ground, says Doughty.”There is some distance between best practice and local authorities thataren’t embracing that. It would be fair to say the best local authorities have between 15% and 20% of assessments producing a telecare referral.”
Specialist referrals team
This should be supplemented with a specialist telecare team to deal with referrals, Doughty recommends. This is better than trying to train too many frontline practitioners to a low standard, which could result in poor provision. And it helps ensure that equipment provided is appropriate, not designed purelyto meet targets.
Doughty is keen for services to be audited and reviewed to ensure the right kit has been provided and responses are adequately followed up.
“Collectively, most local authorities are guilty of not appreciating the significance of the call handling,” he says. “The quality of the service depends on the outcomes achieved. If Mrs Jones has a fall at night, what happens the next day? Do we review the data?”
The last major piece of the puzzle is putting the right technology into people’s homes at the right time. The Whole Systems Demonstrators Programme trials have found it can take typically 80 days to have telecare up and running in someone’s home. That is potentially of little use for someone receiving end-of-life care.
Once an effective model is in place, investment is needed to train teams to stay updated with new technologies, and for publicity to allay the fears of potential recipients.
Suppliers must also take some responsibility and adjust to the needs of commissioners, says Nick Goodwin, a senior fellow at the Kings Fund, who is leading its work on the Whole Systems Demonstrators Programme action network. “Commissioners tend to be quite risk averse and the vendors are selling a piece of technology kit rather then selling a service,” he says. “If I’m investing I want to know it is future-proofed when a better bit of kit comes out. There has to be a change in the nature of that relationship.”
Spend to save
The barriers to the uptake of telecare are complex and depend on how far a local authority is down the telecare road. But now is the time to consolidate the evidence and spend money as a means to save long term, saysAli Rogan, marketing director of telecare supplier Tunstall.
“It would be nice to get another central government grant but I don’t think that’s going to happen,” Rogansays.”We need commissioners out there to have that leap of faith. “The only way to do that is to make telecare part of the main care package.”
The telecare lab
The Centre for Usable Home Technology has a three-bedroom bungalow on the University of York campus that is furnished as a “living home” laboratory.
The responsive home has demonstrations of technologies and equipment for recording and analysing user behaviour in a domestic setting. This facility can be hired for meetings and as a viewing facility for user studies.
The kitchen contains different technologies to support independent living. These include a sink that can be raised and lowered for wheelchair users, a telecare monitoring system, a fridge that can give spoken advice about its contents, which is beneficial to people with cognitive problems, and an easy-to-use mobile phone with just two buttons. The two-button phone displays a picture of those whose numbers are programmed into it. The user has two choices: “yes” (phone this person); “no” (show me another).
More details: 01904 433178 and CUHTEC
Essex pioneers telecare
Essex has a population of 1.3 million and a large older population, so it is little surprise that the council has taken up telecare quickly to help support them. The preventive technology grant created 5,662 new telecare users, and the scheme was so successful that this financial year the council has invested £4m to help finance free equipment, installation and service charges for one year for the over-85s, and for 12 weeks for those under 85 and eligible.
To deliver telecare to more people faster, 1,500 professionals in both the council and the voluntary sector have completed training to commission telecare services as part of their everyday work. “We wanted telecare to be a mainstream service from day one,” says Gary Raynor, the telecare service development manager at Essex Council.
Raynor claims that the benefits of telecare are now spreading by word of mouth, but that professionals sometimes need persuading. “At training, I say I’ve got a pound in my pocket that I will give to anyone who can show me another government service that people want that actually saves money,” he says. “No one has taken that pound off me yet.
The one-day training session provides case studies of fellow professionals speaking about their experience of telecare – the “light bulb” moment, according to Raynor, for many converts. Staff can then also refer to a specialist telecare team for cases beyond their training.
Despite that effort, only 40% of those who have received training commission telecare in volume, so a series of masterclasses to consolidate people’s knowledge has been developed, and has so far been delivered to 180 people.
This article is published in the 11 June issue of Community Care magazine under the heading Brave new world