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Emerald Group Publishing Limited
Copyright © 2012, Emerald Group Publishing Limited
Article Type: Service news From: Housing, Care and Support, Volume 15, Issue 1
Transforming integrated care – using telecare as a catalyst for change
Frances ThompsonFrances Thompson is Assistive Technology Development Manager at Wakefield Council, Wakefield, UK.
This article discusses how to successfully mainstream telecare to transform service delivery and provide more preventative and personalised care for people of all ages and abilities.
The city of Wakefield is a metropolitan district of West Yorkshire, England, with a population of approximately 324,000. Wakefield Council is the local authority responsible for providing or commissioning a range of services to the citizens of Wakefield, including social care, schools, environmental health, housing benefits and waste collection.
Telecare is the use of technology and support systems, such as door sensors, smoke detectors or flood sensors, to assist vulnerable people by improving and improving well-being and maintaining independence, enabling individuals to live safely and securely at home for as long as possible. At Wakefield Council, we have recognised the potential of telecare and now offer it to people of all ages and abilities.
Wakefield’s telecare provision has demonstrated great success and is now a mainstream service, integrated into our assessment process. Our comprehensive, three-year evaluation spanning 2007-2010, aimed to consider how successful telecare has been in supporting a wide number of people covering all ages and abilities. It also looked at how telecare is promoting independence and wellbeing and deferring admittance to hospital or residential care whilst providing cost effective care and support.
Outcomes have been supported by the Department of Health’s recently announced results from the Whole System Demonstrator programme, and the Government’s commitment to supporting the new “3millionlives” initiative, which aims to transform the lives of three million people with long-term conditions or social care needs by utilising telehealth and telecare within health and social care services.
Coupled with the positive outcomes for individuals, one of the most significant results from the evaluation was the financial savings we achieved after only one year of telecare support. We conducted an assessment of 135 participants (all ages and abilities) using telecare, and calculated net savings of £1,325,753 in one year, which is based on the cost of the current care-plans, deducted from the allowable residential care admission costs.
Alongside the management of adults and older people, telecare has also had a positive impact on the support of people with learning disabilities. An evaluation was carried out on a random selection of 68 people from adults, older people and learning disabilities. The efficiency outcome was determined on the prevention of service users entering residential care and the resulting net cost saving was £863,371 per year, with an average saving per person amounting to £12,696 per year.
So how did we approach the integration and mainstreaming of telecare into our care service provision and what are the key components to ensure success?
Personalisation is key
From the start of our telecare project we embraced partnership working, collaborating with Wakefield District Housing (WDH) Care Link Call Centre, Northern Housing Consortium, Barnados, Carers Wakefield District, Kids (WeSail – Wakefield’s Early Support Advice Information Liaison), South West Yorkshire Partnership NHS Foundation Trust, commissioned care providers, Tunstall and other key stakeholders providing equipment.
True personalisation requires the integration of all services around the individual in order to ensure that assistance is targeted and there is an economy of effort in their delivery. An integrated telecare model reduces the risks for those living at home, ensures a prompt and appropriate response to emergencies and delays unnecessary admissions to residential or nursing care. But of course, care services are not “one size fits all”. These services need to be tailored to the individual’s needs.
Our evaluation has demonstrated that telecare can help people maintain independence, delay or even eliminate the need for residential care. It is important to note however, that telecare is not a replacement for human care: rather, it should be regarded as a supplement to help restore independence and dignity that may otherwise be lost, while providing a great deal of support and reassurance for family and carers.
Prevention is better than cure
In line with Wakefield’s Commissioning for Transformation, telecare can provide preventative support to ensure problems are detected and addressed early on. In Wakefield, telecare enabled a reduction of over 12,200 hours in deferred residential admissions, (based on 135 users). Coupled with the considerably higher number of over 65s referred (over 65s account for 85 percent of all referrals received as at December 2010), it is clear that telecare has enabled adults and older people to remain living in their homes for longer.
We also discovered the highest number of referrals were received for those at high risk of falls with over 275 referrals, which is comparatively high considering the list of 32 primary reasons had an average of 50 referrals. Each resident considered to be at high risk of falling was provided with a person-centred package of care integrated with telecare, which could include a community alarm and pendant, fall detector and bed sensor.
In addition, a response service was developed jointly between WDH Care Link Call Centre and Wakefield Family Services. The responders are available to respond 24 hours seven days a week to help people in their own homes who may have fallen for example, and to reduce to number of calls to 999 ambulance service. This service helps to reduce the number of people who are taken to hospital unnecessarily, it gives families and service users peace of mind knowing someone can respond to a call for help and gives the older people the confidence to remain in their own homes.
Supporting people with complex needs
The innovative use of telecare has enabled us to broaden the scope of assistive technology, supporting more people including those with learning and physical disabilities, as well as children with complex needs, young carers and the voluntary sector.
By embracing the flexible nature of telecare amongst other projects, Wakefield has been able to develop two self-contained properties to support those with a wide range of learning disabilities and reduce night support by providing a telecare package suited to individual residents’ needs.
Each apartment was provided with a community alarm and pendant and any other telecare equipment, tailored to meet their individual needs. The importance being that all residents have a feeling of being safe and able to contact support immediately if necessary. The resident is able to speak with a support worker via their mobile Dect handset, which is carried with them at all times. This system also reduces the need for waking staff, as an alert to wake the sleep-in staff has been installed.
Making smarter homes
To successfully integrate and mainstream telecare, there needs to be adequate training and assessment for all staff involved in the implementation in order to deliver a sustainable and deliverable telecare service. By using an effective assessment process, you can improve the lives and well-being of people with long-term conditions and social care needs.
We focus on the discreet nature of the technology, as it is so important not to allow telecare to be intrusive for the individual.
We use a “Smart House” facility to assist with induction and awareness for all professional staff, carers and service users. This is also provided as a resource to people beyond the Wakefield boundary.
Supporting timely hospital discharge
Building on the existing work on timely hospital discharge in Wakefield, our evaluation demonstrates that over 2,600 referrals were received from 2007-2010 from a variety of sources. 25 percent came from the hospital discharge and social work teams at the hospital, helping the timely discharge of patients back home. The aim was to speed up recovery, facilitate re-learning of essential day-to-day personal care skills and re-build self-confidence in the ability to look after his or her self. Telecare supports this process by managing risks and offering cost effective, ongoing support through the reablement period.
Caring for carers
Our service has demonstrated how telecare facilitates greater independence for carers, in particular young carers, who feel safe in the knowledge that, if they ever need help, 24-hour responders are on hand to attend around the clock. The service has also been instrumental in ensuring families with young carers have the practical and emotional support needed to stay together as a unit, avoiding additional care costs and relieving some of the stresses associated with being a carer.
Telecare has also proven invaluable in supporting parents who have children with complex needs. A large number of families struggle to remain together when they have a child with complex needs but by using telecare effectively, families can have minimal intervention with maximum security, ensuring the risks in the household are reduced and peace of mind for the parents.
Future of telecare
There is no doubt that telecare technology has huge potential to impact on the way care is provided in the UK, and has insights to offer any provider of national programmes or local services where independence is central to social policy. It is proving to be an excellent tool for giving greater independence to service users, especially those with learning disabilities and our success has demonstrated that in addition to service users themselves, there is a positive impact on the lives of carers as well, who find they too have gained independence.
We need to continue to achieve successful joint working with both health and social care teams to consider all aspects of telecare and telehealth to achieve independence and better outcomes for people. By focusing on people with long-term conditions, dementia and complex needs, we recognise the need to look at more innovative solutions for people that includes telecare and telehealth. It is not just about saving money in social care but also for the health economy. This can only be done by providing integrated solutions for people and looking at more innovative and economic support packages for the service users of all ages and abilities.
The economic benefits are significant and evident of a comprehensive and sustainable approach to service delivery in Wakefield, which is vital in supporting the Prevention and Health and Wellbeing Agendas. The cost efficiencies are crucial when considering the future of telecare and, with significant cost savings made over a relatively short period; the potential for future investments is a significant factor for the continuing delivery of excellent services.
1. A digital wireless technology that originated in Europe for cordless telephones, wireless offices and wireless telephone lines to the home.
2. A demonstration facility that incorporates built-in sensors and technologies that support independence, health and wellness.
3. Strategies that have been introduced by the current UK Coalition Government which look at ways to promote the health and well-being of the local community and population as a whole, ensuring that individuals are in a position to reach their full potential and get the most from their lives.