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.
Emergency
indicators
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."
For more on
Wsdan
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