Push button care

Remember the first time you used a hands-free toilet? How at first
you couldn’t find the flush but then, as if by magic, it suddenly
flushed itself as a result of your unknowing frantic gestures in
front of what must have been the sensor?

When they first hit the market, hands-free toilets and taps were a
cause of amusement, but over time they have become more
commonplace. In years to come, the same could be true of other
household gadgetry. With the development of so-called “smart”
homes, more and more everyday actions could be carried out at the
click of a finger – or at the push of a button at least.

Fridges will be able to check their own contents; washing machines
will be able to alert people to foreign items – such as a red sock
in a load of whites; and robotic vacuum cleaners could make
cleaning carpets a thing of the past.(1)

Affording such products could be some way off for most of us, but
voice-controlled lighting, automatic curtain opening, and CCTV
monitoring are certainly within reach. And the advantages,
particularly for older and disabled people, are obvious. With the
help of technology such as this, older people will be able to stay
independent and in their own homes for longer – something which 90
per cent want to do.

But a concerted effort is required on behalf of all those involved
in the care of older people to achieve this technological dream.
For as the House of Lords science and technology committee reported
in July, the “immense potential” of technology to improve older
people’s quality of life is, at the moment, far from being
realised.(2)

The government has, however, taken a significant step to address
this by publishing guidance on how councils should build telecare
services.(3) It has put aside £80m to try and help an
additional 160,000 older people live safely at home via the
preventive technology grant that will be allocated to councils with
social services responsibilities for two years from April
2006.

But is telecare the right way forward? Is using technology just an
easier and cheaper way of dealing with the increasing numbers of
older, frailer people? And is it something that older people
want?

Over the next 50 years the number of people over the age of 65 is
set to increase by two-thirds from 9.3 million to 16.8 million and,
clearly, this has major workforce implications. If all older people
who need support are to receive it, then making more use of
technology could be essential.

As Lucianne Sawyer, president of the UK Home Care Association,
says: “There is a major problem with staffing – a national crisis –
and so anything we can do to help support people in their own homes
is something we have to try.”

Care services minister Liam Byrne points out in his foreword to the
DH’s telecare guidance that “it is not realistic to plan to deliver
care and support services in the way we do at present”. That may
be, but is there a danger that putting too much emphasis on
technology will be to the detriment of service users? Can a gadget
really be a substitute for face to face care?

Sawyer dismisses the suggestion: “There absolutely has to be a
balance. We’re not talking about replacing hands on care.” After
all, domiciliary care work mostly involves looking after
increasingly dependent clients and carrying out mainly personal
care duties such as dressing, toileting, and help with eating, and
as Sawyer says: “As far as I’m aware, telecare doesn’t do those
tasks. I haven’t
yet found a telecare system that wipes people’s bottoms.”

But that’s not to underestimate telecare’s potential. Lifestyle
devices, such as gadgets that detect whether a person has gone into
their fridge at their usual time, can raise the alarm if something
is amiss and ensure that assistance is delivered immediately. Other
devices are able to stop disasters from happening in the first
place, perhaps by shutting off the gas supply or providing a
flooding alert.

To date, applying the necessary technology has not been a priority
for health and social care providers. Yet making more use of
telecare devices would appear to provide a solution to several of
their problems. Telecare-supported home care would help local
authorities and NHS trusts keep their delayed discharge figures
under control. According to a report from the Audit Commission, it
would replace the need for hospital admission in 5 per cent to 15
per cent of patients aged 70 and over, while reducing the average
length of stay in hospital by between 20 and 60 per cent.(4)

At the same time, it would help local authorities, health trusts
and other organisations to meet policy aims and targets. For
example, a key part of the National Service Framework for Older
People focuses on falls. Telecare equipment, such as the bed sensor
which goes between the mattress and bed base and alerts a response
centre if the person is not back in bed within a certain time, will
help to monitor falls and ensure a speedy response.

Local authorities should also be attracted by the cost savings that
could accrue. Durham Council has for several years run a project
aimed at keeping people at home with the use of technology. It has
found that with the help of telecare, people can be supported in
their own homes for much longer – sometimes for as long as a year –
and that saves the council money that would otherwise be spent on
residential care. The cost difference between a £280 bed
sensor and a long hospital stay is huge.

But how do older people feel about this level of technology
intruding into their lives? Claudine McCreadie, research fellow at
the Institute of Gerontology at King’s College, London, disputes
the idea that older people are technophobes.

“On the whole, if people feel they have a need for something, they
are very accepting about a whole range of technology. It’s a
complete myth that older people are anti-technology.”

In fact, more older people are becoming accustomed to using
gadgets, with TV remote controls, DVD recorders and microwaves now
being everyday items. But McCreadie says that the design of the
equipment does not always add to its appeal.

“Some of the things are very medical in the way they are designed.
How many people want to put a bit of white plastic with a red
button around their necks? People don’t want intrusion that makes
their home look like a hospital.”

It is also essential that the equipment is simple, and works
properly. McCreadie says she knows of a man in his nineties whose
fall detector went off every time he got out of his chair.

Despite recent advances in the telecare world, it is clear that
there are still practical and ethical concerns to be ironed out.
However, provided it is used in conjunction with, and not instead
of, face-to-face personal contact, it would seem that there are
benefits to be had all round. If this proves to be the case, then
government interest in telecare is unlikely to be a flash in the
pan.

(1) Smart Home – A Definition, Housing Learning and
Improvement Network, 2003
(2) Ageing: Scientific Aspects, House of Lords science and
technology committee, 2005
(3) Building Telecare in England, Department of Health,
2005
(4) Assistive Technology: Independence and Well-being 4,
Audit Commission, 2004