Telecare technology has developed considerably, providing a solution to the conundrum of maintaining independence without compromising security.
Research carried out recently amongst more than 2,000 adults aged 65-93 found that one in six had hidden a serious injury, illness or accident from friends or family, because they feared losing their independence or being seen as burden. 12% of these said they thought they would be seen as incapable of looking after themselves and 11% were scared about having to go into hospital. Half wanted to avoid their nearest and dearest over-reacting, and more than two thirds (67%) didn’t want to worry them.
At the same time, the NHS and social services are keen to find cost-effective ways of enabling people to continue living independently in their own homes for as long as possible.
Technology can often provide the answer.
The original telecare option, the telephone-based alarm, is now available in various guises. The classic landline with panic button and pendant fall alarm is still a popular choice, but many people now carry a mobile phone with them at all times – so why not have the telecare alarm incorporated into that? Alternatively, some people find the idea of an alarm pendant unappealing, but are much more comfortable wearing a watch that fulfils the same sort of purpose.
As tablets and smartphones have become more universal, systems are being developed to use them in support of independence. A dedicated tablet is available (shown left) preloaded with software to enable the user to stay in touch with family or carers; summon help an emergency; be reminded about appointments or medication to take stock
GPS tracking technology can now be used as part of a telecare package, to monitor the well-being of someone when they are away from home. Integrated into a phone or a separate device (right) which can be slipped into a pocket or attached to a mobility scooter, it can be used to trigger an alert if the user moves outside a pre-defined area, for example.
As well as the basic alarm/alert function, telecare services can incorporate a range of monitors and sensors. These could be triggered when, for example, a person falls or has a seizure; or when gas or smoke are detected, so that appropriate help can be provided. Sensors can also detect such problems as intruders or bogus callers, and summon help. Technology can also help to prevent problems: for example, a spoken reminder to turn off the cooker can help prevent a kitchen fire; or a bed sensor could turn on the light when it detects a person getting out of bed in the night, thus helping to prevent a fall.
A service that is often referred to as “lifestyle monitoring” can be incorporated. Tailored to suit individual circumstances, the system relies on a series of movement sensors in strategic locations around the home which build a log of the user’s movements as they go about their daily routine. Carers can then quickly identify any changes in habitual behaviour which may be indicators of deteriorating health or increasing mental confusion.
To deal with the problem of enabling legitimate callers to gain entry to the home, while maintaining the security of the occupant, solutions include the key safe, where a spare set of door keys are held in a small secure box on the wall, with a coded keypad to open it, and remote access systems, with an audio or video intercom and remote unlocking device. Click to go to our section on door entry systems where you will find more details.
The Department of Health launched the largest randomised control trial of telehealth and telecare in the world in May 2008, involving 6191 patients and 238 GP practices in three areas: Newham, Kent and Cornwall, and known as the Whole System Demonstrator (WSD). The trials were evaluated by: City University London, University of Oxford, University of Manchester, Nuffield Trust, Imperial College London and London School of Economics.
Although the WSD has not delivered any clear-cut financial savings (which the DH was hoping for), there are some encouraging results from the telehealth trial, which involved 3154 patients with diabetes, COPD or heart failure. Using a range of telehealth monitoring devices, the following results were achieved, compared with a control group receiving normal care:
45% reduction in mortality rates
20% reduction in emergency admissions
15% reduction in A&E visits
14% reduction in elective admissions
14% reduction in bed days
8% reduction in tariff costs
The most significant outcome from this trial, is probably that people who are able to keep tabs on their medical condition regularly, are less likely to have a sudden deterioration leading to emergency admission to hospital, because small changes will be picked up more quickly.
Another part of telecare/telehealth, which has produced some very good results in trials. Every year the NHS spends almost £9 billion on medication, issuing a staggering 927 million prescriptions, and the National Audit Office estimates we return more than £100 million in unused drugs, which are then destroyed.
In 2006-07 the cost of hospital admission in the UK resulting from patients not taking their prescribed medication properly was estimated to be somewhere between £36m and £197m. Medication management systems which remind people when to take their pills, and dispense just the right amount, have been shown to make savings by preventing hospital admissions for over-or under-medicating, and avoiding the need for visits to remind people to take their pills. The well-being and confidence of the individual, who knows that they don’t need to worry about missing a dose or doubling up by mistake, also has a beneficial effect in other areas of their life.
You can read some case studies from PivoTell here.