Unobtrusive night-time monitoring and support is being made possible by assistive technology, reports Louise Hunt
● Name: United Response’s assistive technology work in Ashford.
● Aims and objectives: To look at how assistive technology can help deliver more person-centred support for people with severe learning disabilities.
● Funding sources: Kent Council (core costs), fundraising and a United Response development grant.
● Number of staff: One assistive technology co-ordinator plus support staff.
● Number of service users: 11
● Outcomes: Greater independence, privacy, and freedom for people with high support needs, while minimising support costs.
Night-time support for people with severe learning disabilities can result in disrupted sleep patterns, and loss of independence and privacy. But one residential care service in Ashford, Kent, has found that assistive technology is improving outcomes for residents while reducing staffing costs.
The centre, run by charity United Response, houses 11 people with learning disabilities in individual and shared flats. It is part of a two-year pilot, launched last October, in which the charity is employing three assistive technology co-ordinators in different services to develop solutions that increase independence for residents of its services.
At the Ashford centre, which is the furthest advanced, a range of assistive technologies that detect residents’ movements at night are linked to a pager system, carried by two sleep-in staff, who can provide support when needed.
An end to waking night support
This approach is part of an evolution away from the use of waking night support, which requires carers to check on residents throughout the night. This system was commonplace in long-term NHS care institutions for people with complex learning disabilities, but Martine Norton, United Response area manager for Kent, says it created a culture of 24-hour activity that did not encourage natural sleep.
“On the surface of it, all-night support may look like the best way to ensure the safety of an individual at night, but when you look in a person-centred way at a person’s behaviour you often find that this is not in their best interests, both in terms of privacy and in encouraging the development of a natural night-time environment.”
The move from NHS care into smaller community facilities such as the Ashford centre has presented an opportunity for people with learning disabilities to have their needs re-assessed, and, where appropriate, assistive technology has been gradually introduced into care packages.
“Assistive technology has provided us with an alternative to waking night support. Used in the right way, it can help to manage risk at the same time as giving people their space and independence,” adds Norton.
For example, a laser-beam sensor can detect if someone leaves their room and sounds an alarm if they do not return within a certain period of time. Epilepsy detector mats can monitor an individual’s vital signs to detect a range of seizures. For people with incontinence, moisture sensors can be placed within the bed to provide an immediate alert.
One of the benefits of using assistive technology is that it shows the frequency of alerts, and if episodes of wakefulness are part of a longer pattern of disturbance that may need investigation.
Occasionally, short spells of waking night support may need to be reinstated. However, though most Ashford residents need 24-hour support, none currently has waking night support.
Understandably, the families of residents may need some convincing that it is okay to rely on machines rather than people to monitor their loved ones. “We don’t take any decisions on care without informing families. If someone is assessed as needing 24-hour support we would sensitively discuss with the family how assistive technology can be used within their package of support. It is a question of working with relatives to reassure them that we are not increasing risk,” says Norton.
That the use of assistive technology can also reduce support costs is a “happy coincidence”, adds Norton, who emphasises that its introduction has been driven by “a genuine desire to deliver more person-centred care”.
Nevertheless, cost-efficiency is an unavoidable consideration for local authority commissioners and the combination of assistive technology and sleep-in support makes it possible to reduce staff numbers.
Penny Southern, commissioner for learning disability services for Kent Council, says there is anecdotal evidence that this approach can be more cost-effective. However, she adds that more analysis is needed to determine to what extent a reduced reliance on support is influenced by behaviour change among residents who have moved from NHS care settings into their own flats.
She hopes that a formal county-wide review looking specifically at 120 people with learning disabilities who have been transferred from NHS care to supported living arrangements will shed more light on the benefits of assistive technology.
It will look at whether it has worked for individuals, whether it is being used correctly by staff and whether it has reduced support costs.
A report is expected later this year. In the meantime, Southern advocates the approach taken by United Response. “It is definitely giving people more independence,” she says.
Case study: ‘We can manage his epilepsy now’
David*, who has complex needs, moved to the residential care service in Ashford three years ago, having previously lived in a unit that employed waking night staff. “Because he previously didn’t receive much attention during the day he slept a lot and regularly missed out on daytime activities, so he would get up a lot during the night because he felt it was the only way to gain more contact with people,” says service manager Liesl Cooper.
After moving to the Ashford centre his waking night support was phased out, while staff observed his patterns of behaviour at night. They noticed that David would be up nine to 12 nights a month. During these nights he would constantly pace backwards and forwards, and there seemed to be a link between the pacing and his epilepsy. “It was clear that he didn’t need waking night support all the time, only in those clusters, and we realised he didn’t want anything from us when he was pacing other than to make him comfortable,” says Cooper.
The team decided to look at ways that assistive technology could be used to ensure that David was safe and had the space he needed on the nights that he was pacing, without him being unnecessarily disturbed on other nights.
They began by introducing an epilepsy alarm on David’s bed in case he experienced a seizure in his sleep. But with David’s habitual pacing it was also important to monitor him when he was out of bed, so they introduced a movement sensor mat beside his bed so staff would know if he got up in the night. A further mat was placed near the stairs in David’s flat. His epilepsy management and medication were also reviewed.
Since these changes were introduced, David’s epilepsy has become more stable and the number of nights he is up pacing have decreased significantly, leading to a better quality of life – and being able to live in his own flat. “He has a much busier lifestyle now. The technology has helped him get out and about more because he sleeps better at night. When he joined us, he just looked at the ground, now he engages with us. Technology has given him the freedom to be as he needs to be,” says Cooper.
* Not his real name
(Picture by Tom Parkes)
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