By Louise Eastwood
While many local authorities decided to diversify staff responsibilities to encompass telecare within existing services, Hull Council decided that in order to maximise support for residents in a way that did not compromise ongoing social care, it would create a dedicated telecare team to offer help and guidance to residents, carers and service providers 24 hours a day.
Hull is home to a population of 265,000; 14% are over 65 and nearly 29% have a long-term illness or disability. Given the nature of the local population, it’s our responsibility to deliver services that support residents as their needs become more complex.
The telecare team was established to improve the safety and welfare of residents in the city, particularly those who are older, perhaps with dementia; those who have been recently discharged from hospital; and carers.
There are eight members of staff: four co-ordinators who go out to assess each referral and four technicians who fit the equipment and carry out annual maintenance calls. The background of the co-ordinators is varied; two have a care background, one has a housing background and the other came from the voluntary sector.
They work very much as a team and share knowledge and understanding of the products. Together they carry out monthly meetings with a telecare support engineer from Tunstall to reaffirm their understanding of programming the equipment, ensuring we get the best results for our residents.
Many referrals are received from hospitals when patients are ready to be discharged. Kingston Care Lifeline Service advises the team each time it gives a lifeline to a new user, who will then be contacted to establish whether they would benefit from additional telecare sensors. Everyone who receives a social care assessment will also be automatically offered the telecare service.
In some cases patients cannot be discharged until they have a live telecare service at home, and up to 10 times per week the team will undertake a same day telecare assessment and installation to enable and support rapid discharge.
The assessments are generated and integrated onto the council’s database CareFirst. When a new service user is logged onto the system, it automatically generates a referral to the telecare team to follow up. The social worker or social work assistant is then able to follow the progress of the referral and see what equipment is being installed. An equipment agreement is recorded on CareFirst so anyone involved with the case can see what has been installed and why.
We do not currently set eligibility criteria for telecare; it is purely needs-based and therefore anyone can have environmental equipment such as smoke alarms, as long as they have a lifeline. Any sensors that help with specific needs such as enuresis sensors (for incontinence) are based on the actual need of the service user.
Support for carers
The telecare team also offers support for carers with dependent relatives, often using a lifeline home unit and sensors linked to a pager. This enables the carer to undertake normal daily tasks, such as going out in the garden, having a good night’s sleep or enjoying leisure time, in the knowledge that they will be alerted if the person they care for needs assistance.
Carers can also be supported during the night by the Hull out of hours team (HOOHT). From 9pm–7am, all alerts from the telecare sensors can be directed to HOOHT, who will send a response officer rather than waking the carer. This gives carers respite by providing a safety net where incidences during the night are rare. Telecare and the out of hours team are reducing the need for more costly interventions, such as waking night care or residential care, saving money and protecting people’s privacy.
Telecare and dementia
There are approximately 800 people in Hull registered with care services who are living with dementia. Using telecare solutions means that they are safeguarded, and their carers are under less stress.
The council recently launched the Hull Dementia Academy Action Alliance which aims to help professionals and carers provide improved support to people with dementia, improving the quality of life for people with the condition and helping to reduce the number of admissions to hospital and residential care. Telecare is reducing the need for waking night home carers, supporting Hull to become a dementia friendly city.
For example, one woman with dementia who still lives independently has a prompt reminder on her lifeline that is recorded in her daughter’s familiar voice reminding her not to go out when it’s dark. This is linked to a sensor on the front door so the message plays when the door is opened. The sensor alerts the call centre if the door opens and they then contact the daughter. And as this client is still quite active in the kitchen, a heat head has been fitted in case something burns or is set on fire.
We have also used the CareAssist pager very successfully for couples where one of them has dementia, The CareAssist pager can be used with fall sensors, door exit sensors and bed and chair occupancy sensors depending on the need. It allows the carer peace of mind to know they will be alerted should a front door open or the cared-for person falls or gets up and they are not in the room.
And telecare can support people in assisted living environments, as well as in their own homes. For smaller residential homes without integral communication systems, a pager can be used to enable telecare to be deployed to support residents and staff. Hull is currently developing 400 new extra care apartments, which are due to be completed in 2016, where telecare forms an integral part of the development.
Working with the fire service
Whenever Hull’s fire and rescue service identifies a need for a smoke alarm it will install a battery operated smoke detector as a safeguarding measure, then refer the user to the telecare team to have a monitored smoke detector installed.
In circumstances where an individual is at risk of fire due to cigarette embers, smoking sprinkler systems can be installed. Hull’s fire and rescue service is seeing the benefits of monitored smoke detectors; approximately 15 systems are currently in place and they raise an alert at Kingston Care’s control centre if a potential fire is detected, even if the sprinkler action means the smoke detector isn’t activated.
We are still trying to evaluate the impact of telecare on social care, although we already know that several lives have been saved by the monitored smoke alarm alerts. We have found that we are deploying more complicated equipment to help people with complex needs to stay at home. At present there is a project manager looking at how to monitor and record the savings that telecare can provide.
Overall, the telecare team is making a positive difference to hundreds of people’s lives in the city and enabling health, housing and social care providers to support people with long-term health and care needs in a more cost-effective way.
Louise Eastwood is older people mental health team manager at Hull Council