What is Telecare?

Tele (at a distance) Care.

"Telecare describes any service that brings health and social care directly to a user, generally in their homes, supported by information and communication technology. It covers social alarms, lifestyle monitoring and telehealth (remote monitoring of vital signs for diagnosis, assessment and prevention).

Telecare covers a wide range of equipment (detectors, monitors, alarms, pendants etc) and services (monitoring, call centres and response). 

Telecare equipment is provided to support an individual in their home and tailored to meet their needs. Telecare services range from a basic community alarm service that is able to respond to an emergency and provide regular contact by telephone to an integrated system that includes detectors or monitors (ie motion, falls, fire and gas) that trigger a warning to a response centre. More complex systems include telemedicine, which is designed to complement healthcare via monitoring vital signs such as blood pressure. Data is transmitted to a response centre or clinician’s computer where it is monitored against parameters set by the individual’s clinician."

http://www.pasa.nhs.uk/PASAWeb/Productsandservices/Telecare/LandingPage.htm

Telecare is the ability to harness simple technology to enable and empower people such that they can live independently in the community. Telecare also has applications within residential accommodation such as sheltered or extra-care housing where it can be used to support people within existing structures.

Telecare can come in two forms: standalone and Lifeline:

Standalone equipment, whilst 'not strictly' telecare can provide local alerts and support informal carers in the community. For example, when a person gets out of bed an alert signal is sent to the carers bedside so assistance can be forthcoming. Standalone devices can also assist people with memory difficulties by producing voice alerts or suggestions, such that if a person opens the front door they are gently reminded and guided to return to bed or sit down again.

Lifeline telecare sends alerts to a call center who decide on the most appropriate action to assist the person who is having difficulties. There are clear gains here, as it allows other professionals into the care pathway. An example of when this is very important could be in the event of a fire, a call centre could call the fire brigade, call the person with the telecare and call a carer to support the telecare user. A traditional smoke alarm works on a standalaone basis, telecare, on the other hand, enabled smoke detectors send signals to the call centre.

In any installation the choice of what to have should be discussed with the client, the carers and the assessor. Often a combination of equipment is provided (standalone and remote sensing). Sometimes a telecare system might have all remote parts but act like two different systems. For example: a disorientated person opens the from door which produces a local voice alert instructing the person to return to bed and if the door is not closed within a specified time an alert is cent to the call centre.

Telecare Assessment Process

A good place to start understanding the process of getting telecare is to go to the ACT website where the process is outlined clearly. What is clear is that telecare is more than the equipment and is more about the person. Telecare is often referred to as being 'prescribed' but this is somewhat misleading. Some manufacturers have tried to promote, this prescription method basing assessments on a number of medical/social infirmities, but the flaw in this method is that it leads to misdiagnosis as people are not automatons. Clearly this is possibly the fault of the case study approach adopted which focuses on specific activities/infirmities at the expense of the grand picture. As a method there are obvious pros and cons. In the UK there was an advert for the Guardian newspaper which started by showing a skinhead starting to run. Then it shows a different camera angle and you see the skinhead run up to a commuter and wrestle with him for his briefcase. Finally we get a long camera shot: the skinhead spots some crates on a crane have come loose – he runs across to the man who is under the crates, grabs him and pushes him out of the way just in time. The skinhead was’t being chased and he wasn’t going to mug anybody. He had run the length of a street and risked his life to prevent someone being seriously injured, the strapline read "Because things are not always what they seem".

The power of this advertisement is that it allows the viewer to question their own prejudices as well as re-observe at situations without blinkers on. I use to do a number of presentations with students to counter this type of behaviour and often used the example of having a drink at lunchtime to illustrate the point. For many this might be a small quantity of a liquid, for some it might be alcohol, but as the picture below illustrates things might not be exactly as it seems:

In a telecare assessment it is important to look at many things, such as the domestic structure (can you fix what you want to fix where you want to fix it?) as well as the activity patterns (is this a place where the person needs access?). Moreover, as we assess people, it is important to recognise that the technological intervention should not curtail or infringe on a person's human rights and the right to experience risk. We should not put technology in that disables people (as the remote control on the TV disables many millions but stopping them moving whilst watching TV).

We need to be holistic and thorough in our assessments as well as not be complacent and assumptive. We should also try to avoid making generalisations on people due to a similarity in medical condition (two people with similar forms of dementia might often present in different ways and will certainly have different needs). For more information see the Dependability Telecare Assessment tool (DTA).

Enablement versus Containment

It is important to distinguish between the containment model and enablement model of social care. The Containment Model contains older and disabled people by appearing to care about the person, but actually providing little support. This leads people to not challenge the status quo and accept substandard equipment and not challenge poor interventions. Technology is foisted on people using a spurious medical model which can be used to suggest that technology has pseudo-medical properties which it unlikely to have.

The Enablement Model strives to ensure people are personally enabled.  Technological interventions are bespoke and tuned to the person’s actual needs and wishes.  Technology rejection should decline and a person’s quality of life should increase as a result of these interventions.  When developing a system it is important to consider that the telecare system must enable. From a strategic perspective this means that the telecare provider must be able to source from the best locations and not be confined or tied to specific providers. This, of course, means that things becomes a nightmare for standard purchasing agreements and official channels. It also means that the people who are undertaking the assessment for telecare are required to be trained to a higher specification than if they were limited to just one or two manufacturers.

Enablement extends beyond the user of telecare to also enabling the carers, allowing them to have breaks in care whilst still knowing the person they care for is safe. A person using telecare might be enabled to actually fully engage and challenge their environment through having the confidence derived from appropriate technology designed to assist them.

Useful Telecare Sites to check out

London Borough of Barnet Telecare: http://www.barnet.gov.uk/telecare (A good starting point for people living in the London Borough of Barnet)

The SMART thinking Introduction to telecare
http://www.smartthinking.ukideas.com/telecarewhatisit.html

The SMART Thinking Telecare FAQ http://www.smartthinking.ukideas.com/telecare.html (An interesting page to make you think?)

TelecareAware: http://www.telecareaware.com/ (See the useful sites on this page... it is an excellent resource).

The Telecare LIN: http://icn.csip.org.uk/telecare/ (The site that has taken over from CSIP)

The Telecare Services Association: http://www.telecare.org.uk/

FAST: www.fastuk.org

The Social Alarms and Telecare Association: http://www.sata-uk.org.uk/index.htm

AT Dementia: http://www.atdementia.org.uk/editorial.asp?page_id=71 (An excellent site)

Smart Homes and Ambient Assisted Living: An IMIA Working Group: http://www.health-smarthomes.org/ (A useful place to find out some of the most recent research in the area).

Advanced Care Technologies Programme (ACT): http://www.actprogramme.org.uk/ (A very good resource)

PASA: http://www.pasa.nhs.uk/PASAWeb/Productsandservices/Telecare/LandingPage.htm (Where to find the National Framework and other useful documents)