Telecare enabled The future of assistive technology in commissioning services for people Jeremy Port

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Telecare enabled - The future of assistive
technology in commissioning services for
peopleJeremy PorteusHousing Network
LeadChange Agent Team

• 22 February 2005

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Designing for Life
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Telecare

• Included in DH ICES guidance (March 2001)
• Telecare Advisory Group and pilot project (2003)
• Telecare Getting Started pack (revised 2005)
• Audit Commission report (Feb 2004)
• ICES/Audit Commission/CAT Conferences (Summer
  2004)
• DH Green Paper (expected February 2005)
• DH Policy Collaborative till March 2005
• 80m in Spending Review from 2006

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Understanding the language

• Assistive Technology Any equipment or system
  that assists people who have difficulties due to
  age or disability in carrying out everyday
  activities (source R Curry) or a product or
  service that enables independence for older and
  disabled people (source FAST)
• Telecare the remote or enhanced delivery of
  health and social services to people in their own
  home by means of communications and computerised
  systems (source Barnes)
• Telemedicine the practice of medical care using
  interactive audio-visual and data communications
  this includes the delivery of medical care,
  diagnosis, consultation and treatment, as well as
  health education and the transfer of medical data
  (source WHO)
• Smart House A dwelling incorporating a
  communication network that connects the key
  electrical appliances and services, and allows
  them to be remotely controlled, monitored or
  accesssed (source Housing LIN factsheet)

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Features of a Telecare Service
Features of a Telecare Service
Mitigating risk
Safety and security monitoring, e.g. Bath
overflowing, gas left on, door unlocked

• Personal monitoring
• Physiological signs
• Activities of daily living

Information communication, e.g. health advice,
triage, access to self-help groups
The individual in their home or wider environment
Improving functionality
Electronic assistive technology, e.g.
environmental controls, doors opening/closing,
control of beds
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Implementing Telecare

• Over 1.4 million users of community alarms in the
  UK
• 150 social services departments, 303 PCTs, 238
  district councils, housing associations, alarm
  service/ independent providers, demonstration
  facilities
• 138 community equipment services health/social
  services (some housing/education links) majority
  with S31 agreements and pooled funds, single
  point of contact, equipment tracking, some
  contracted services etc
• Seven day delivery for most equipment incl
  telecare (PAF indicator)
• Various forms of funding to date, mostly
  pilots/projects, 80m for 2006-2008
• Policy Collaborative, Getting Started Pack

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Background to Telecare

• Community alarms emerged from concern about
  isolated older people and availability of cheap
  technology in 60s and 70s
• Driven by local authorities and more recently
  housing associations
• Were strongly associated with social rented and
  sheltered housing
• However, there have been huge technological
  advances new products, new wireless
  technologies, assistive technology
• Huge social change too and different ways of
  considering customer and commissioners needs

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Not developing the types of care services needed
in the future fast enough We are far to slow
33 increase in people needing care in next 10
years Demand is increasing more quickly than ever
before
We are sometimes the wrong services providing the
wrong service at the wrong time We need to review
how and where we spend resouces
A case for improved integrated working
Low overall expectation User expectations will
increase in both needs and wants
The rate of change in health care must link to
change in social care housing provision The key
providers must coordinate their services more
effectively
Govt will no longer tolerate poor performance or
slow progress Cash rewards are available to those
willing to change
We are still driving a reactive approach to care
and housing We need to develop enhanced
preventative services
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Assessment including telecare

• Fair Access to Care Services (FACS) Critical,
  Substantial, Moderate, Low Risk
• Single Assessment Process (SAP) assessment
  tools Contact, Overview, Specialist,
  Comprehensive
• Supporting People Support Plans?
• Financial assessment if charging for services
• Self-assessment
• Direct payment options social care assessment
• Self-purchase

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Telecare and hospital admissions

• Telecare has a potential role in avoiding
  hospital admissions as well as supporting
  discharges
• For preventive and admission avoidance approaches
  you will need to look at the models of supporting
  long term conditions (eg heart failure, strokes)
  where there are multiple admissions
• For hospital discharge approaches, you will need
  to look at intermediate care, step-up/down
  facilities, extra care housing, link with home
  improvement or Care Repair agencies etc
• Reducing unnecessary hospital admissions will
  maintain independence for users/carers and
  stabilise costs particularly under the national
  tariff from April 2005

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Making the business case for telecare

• Empowerment of service users better involvement
  in the management of health and lifestyle
  conditions
• Better us of staff time responding to specific
  needs, alerts and circumstances in the home
• Quicker diagnosis and referral for care,
  treatment or other service
• A significant health dividend prevention, and
  reduction of hospital admission or home from
  hospital care
• Support and manage independence in the home
• The glue to a coordinated approach to support
  people at home

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Housing
Temp Phys Dis
Loneliness/ isolation
Care pathway
Falls

• Care homes/Extra care housing

Dementia

• Int Care

• Telecare

Ageing/ Senility

• Home nursing/ADL/Adaptations

Stroke

• Single point of contact

• Case management (Evercare), ADL home nursing

• Chronic disease management/DTOC

• Telecare/telehealth

• Single assessment process

• Home nursing/ADL/Adaptations

User at home
Heart Disease

• Valuing people

• Supporting people

LD/MH
Sensory/ com loss
COPD

• Wheelchairs/ADLs/Adaptations

• Care homes/telecare

• Continuing care

• DFGs

Other Phys Dis
Cancer

• Palliative care

MND, MS
Major Phys Dis
Long term conds
Integrated services to support independence
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Assessment
Care pathway
SAP
Services
FACS
Case Management
Yes
Yes
Comprehen-sive?
Wandering?
Isolated/lonely
Critical?
Falls
Housing
Demetia
Yes
No
No
Nursing/ home care/ specialist dementia care
support
Yes
Yes
Substantial?
Lives alone?
Specialist?
Yes
No
No
Yes
Yes
gt1 fall per month?
Moderate?
Overview?
Int care/rehab
Yes
No
No
Telecare/ telehealth falls monitor, reminders,
wandering, bed occupancy etc
Yes
Yes
3 or more admissions?
Contact?
Low?
No
No
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Enabling Technology

• E

• Eneabling Technology Technology

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Telecare the challenge

• No mainstream telecare in England yet, no joint
  commissioning -Telecare not provided as a care
  option, what happens with practice-based
  commissioning?
• Single assessment still a vision rather than a
  reality in many areas telecare not in CSR
• 150 SSDs, 303 PCTs, 238 DCs, housing assns, alarm
  providers would need to be involved in assessment
  and care planning via SAP/FACS etc with
  information sharing
• Impact of Supporting People reviews?
• Some processes could be lengthy project
  manager, ethics, charging, procurement,
  agreements, training, information-sharing
  protocols etc need to start NOW
• Lack of clarity over what assessed needs to
  address with telecare do we have the evidence?
  High or low FACS?

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Telecare checklist

• The patient or client group to be supported
• The care process to be enhanced through telecare
• The care setting
• The scale of the proposed service (the number of
  patients or clients served)
• The scope of the proposed service (the
  functionality of the service)
• The referral process into the service
• The equipment installation, maintenance and
  monitoring service
• The response service
• The fit with existing care teams
• The capacity of existing care teams to provide
  the response
• The training needs of new and existing staff
• The distribution of costs and benefits amongst
  stakeholders
• The role of private sector suppliers

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Further information

• Housing LIN, Change Agent Team -
  www.changeagentteam.org.uk/housing
• Audit Commission - http//www.audit-commission.gov
  .uk
• ICES Team www.icesdoh.org
• Telecare pack - www.icesdoh.org/telecare
• Policy Collaborative http//www.info.doh.gov.uk/e
  tpc/etpc.nsf

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Future perfect?