Telecare – from a therapist perspective

When I first came across the term ‘Telecare’ I thought that the word was a combination of telephone + care, therefore Telecare. So I had this notion that it was care over the phone.

I wasn’t too far off.

“Telecare is support and assistance provided at a distance using information and communication technology.  It is the continuous, automatic and remote monitoring of users by means of sensors to enable them to continue living in their own home, while minimising risks such as a fall, gas and flood detection and relate to other real time emergencies and lifestyle changes over time”(2).

I am not going to lie. Telecare really excites the OT nerd in me. It is innovative assistive technology, it promotes independence via assistance from afar. The whole concept really reminds me of the Ultrahouse 3000, which appeared in the Simpsons Halloweens Treehouse of Horror XII episode. The Simpsons had decided to upgrade their house to the Ultrahouse. A house with advanced sensor technology that could perform general household duties; butler/valet services; personal physician (telemedicine!); chef duties; and social interaction. Perfect house for the person who needs that little bit of extra care to continue living at home independently.

Yeah. In real life, we aren’t at that stage just yet.

Today, the UK telecare market offers a wide range of alarms and sensors that can be linked to a system that allows the user to be supported by an external monitoring body (1,2). Stand alone monitoring systems are also available; these are generally used when a family member or carer needs to be contacted in the same building (5).

In the past decade, the option of Telecare in the UK has become increasingly attractive. Politicians and policy holders are asking themselves, could Telecare be the cost effective solution needed in todays’ ageing population with growing care needs?

As Telecare gained momentum, a bunch of studies ensued, mostly small scale, showing specific benefits of telecare (10). For the user, telecare gives confidence, support, peace of mind and independence. For the carer, the perceived benefits included reduced pressure on the carer, improved health and wellbeing and improvements in the relationship with the person they look after (10). Powerful individual stories were (and still are) emerging, highlighting the specific benefits and describing the positive impact it has had on users and carers.

Telecare is looking good except for a few small glitches. Despite the many studies and powerful stories supporting the many benefits, there are not many robust studies to show that telecare is cost – effective or that there is a reduction in service use (i.e. hospital admissions) (11, 13). So in recognition of this, the Department of Health launched a large (as in 3000 participants) randomised control trial of telecare in 2006 and the results were not pretty (12). Bluntly put, “In this trial, telecare did not significantly alter rates of health or social care use or mortality over 12 months’ (11). It was not looking better for the penny pinching side of it either; the study also showed that telecare was not a cost effective addition to standard support and treatment (13).

There are also ethical implications that cannot be overlooked. Although the intent of Telecare is to monitor, prevent and protect, it is still like big brother. For consenting users, this is not such a big issue. But for vulnerable users, such as those living with dementia, it can become an issue of privacy invasion and restriction of freedom (7).

Telecare, if inappropriately prescribed, can become hazardous rather than beneficial. Recently, I came across a patient living with Alzheimers, her cognition was very poor and her short term memory non-existent. Family were very anti-telecare because this lady had been inappropriately prescribed a pendant alarm. She did not have the cognitive capability to understand (or remember) the purpose of the alarm, which resulted in frequent pressing of the button. She would become very distressed and further confused when she heard the operator voice over the base unit because she could not understand where the voice was coming from. This put her at higher risk of falls as she would frantically search for the voice.

In light of these glitches, telecare cannot be recommended lightly, particularly when prescribing for a vulnerable adult. It sounds obvious, but we as OTs need to become well acquainted with a telecare product before we prescribe it and our assessment needs to reflect that we have explored the potential risks as well as benefits.

Here are some questions to ask yourself during your Telecare Ax:

Have you gained the persons informed consent to receive telecare? Too often I have found myself about to fax my OT report with the recommendation of a telecare product before gaining the consent of the patient. I know that this product will work, but it is still the patient’s choice whether they want to receive this equipment or not.

If the patient is vulnerable or does not have capacity, have you explored alternative methods to keep this patient safe? Remember, the use of activity monitoring sensors, wander deterrent sensors or movement sensors can be considered a form of privacy invasion and restriction of freedom. Does the risk (i.e. fall) outweigh this persons privacy?

Is Telecare really the solution? Sometimes it is easy to slap on Telecare rather than explore the real problem. For instance, look at this scenario: We have a patient living with Alzheimers with a history of wandering. The team say ok prescribe a wander sensor to keep this man from going outside of his house. What if I told you that this person was a very social being and prior to cognitive decline, would catch up with friends daily? The better solution would be to find a way to support his need for social contact rather than slap on a product that will keep him inside the house. Always look at the problem and try to address that before considering a product that may inhibit occupation.

Will this Telecare product cause more harm than good? For instance, will a pressure sensor mat be a trip hazard? Will the person jump, and therefore be at risk of a fall, if the alarm sounds from a chair sensor? Will the person become distressed and further confused by a memo minder? Always, always, always explore the potential risks that can arise from implementation of a Telecare product.

Telecare may not be the penny pinching answer to the UK social care crisis or offer a significant decrease in social care use, but neither is anything else these days. So do not write it off completely just yet. We are client-centred anyway remember? Not ‘ 3000 participants or one size fits all’ centred. AND there is still evidence to suggest that telecare can be used to help support a person and their carer to live at home longer and independently. So add Telecare to your OT toolbox and remember to prescribe it wisely.

Question for the day:

What is your Telecare success story?

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REFERENCES:

1. Aktiv UK 2014, ‘The evolving UK market for Telecare.’ Retrieved March 9, 2015, from http://www.aktive.org.uk/downloads/Evolving_UK_market_for_telecare.pdf
2. Telecare Services Association. (n.d.). What is Telecare? Retrieved March 9, 2015, from http://www.telecare.org.uk/consumer-services/what-is-telecare
3. What is Telecare? (n.d.). Retrieved March 9, 2015, from http://www.uktelehealthcare.com/whatistelecare.asp
4. Lloyd, J. 2012, ‘The future of who uses Telecare’. The strategic society centre 2012.
5. Sirona Care and Health. (2015). Telecare Service. Retrieved March 9, 2015, from http://www.sirona-cic.org.uk/services/telecare-service/
6. CarersUK. (2014). Telecare and telehealth. Retrieved March 9, 2015, from http://www.carersuk.org/help-and-advice/practical-support/equipment-and-technology/telecare-and-telehealth
7. Social care institute for excellence (2010) SCIE Report 30: Ethical issues in the use of telecare. Available from www.scie.org.uk/publications/reports/report30.pdf
8. Ward, G., Holliday, N., Fielden, S. and Williams, S. (2012) Fall detectors: a review of the literature. Journal of Assistive Technologies Vol.6 (3) p202-215
9. Disabled Living Foundation 2013,Fact sheet-Personal Alarm Systems and Telecare, UK, viewed 9th March 2015 from http://www.dlf.org.uk/factsheets/factsheet_telecare_ref.pdf
10. AKTIVE Consortium (2013) The Role of Telecare in meeting the Care Needs of Older People: themes, debates and perspectives in the literature on ageing and technology. AKTIVE Research Report Vol.1, online publication: www.aktive.org.uk/publications.html ISBN: 978-0-9570900-3-3
11. Steventon A, Bardsley M, Billings J, Dixon J, Doll H, Beynon M et al. Effect of telecare on use of health and social care ser- vices: findings from the Whole Systems Demonstrator cluster randomised trial. Age Ageing 2013; 42: 501–8.
12. Bower P, Cartwright M, Hirani SP, et al. A comprehensive evaluation of the impact of telemonitoring in patients with long-term conditions and social care needs: protocol for the Whole Systems Demonstrator cluster randomised trial. BMC Health Serv Res 2011;11:184.

13. Catherine Henderson, Martin Knapp, José-Luis Fernández, Jennifer Beecham, Shashivadan P. Hirani, Michelle Beynon, Martin Cartwright, Lorna Rixon, Helen Doll, Peter Bower, Adam Steventon, Anne Rogers, Ray Fitzpatrick, James Barlow, Martin Bardsley, and Stanton P. Newman. Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial. Age Ageing 2014 : afu067v1-afu067.