State of the Art in Dementia Care

Assistive technology, housing and telecare

1 July 2008

Mike Clark leads the Telecare and Telehealthprogramme for CSIP Networks working with health,housing and social care commissioners and serviceproviders to develop integrated services to supportpeople at home in a wide range of settings.

CSIP Networks provides a wide range of services tosupport housing, commissioning, leadership,personalisation and integrated care programmes.

www.icn.csip.org.uk/telecaretelecare@csip.org.uk

Home Sensors – CO, PIR, pressure mat etc- Spec 11.1.1, 11.1.2 and 11.1.3

Alerts, measurements in the home –bells, sirens, screen readout

Community alarm –handset/pendant – Spec 11.1.4and 11.1.3

Sensors worn byusers, falls, wristcare,wandering etc – Spec11.1.1, 11.1.2 and11.13

Housing systems,door entry, boguscaller - Spec 11.1.2and 11.1.3 Medication monitoring

– Spec 11.1.11

Alerts to users, carers etceg pagers

Installation, maintenance

Monitoring (includingparameters),response/call handling

Other AT devices

Telehealth units – Spec11.1.3

Environmentalcontrols – Spec11.1.3

Alerts, info tomobilephones, homePCS etc

Telehealth peripherals – glucose, peakflow, weight etc – Spec 11.1.2 and11.1.3 also 11.1.5, 11.1.6, 11.1.7

CamerasSpec - 11.1.2

Standalone glucosemonitors – Spec 11.1.6

Cameraphones -Spec 11.1.2

Home visits,users/carers,emergencyservices,clinicianresponse etc

Autodiallers, phone line, 3g/GPRStransmission modules, broadband

Autodiallers, phone line, 3g/GPRStransmission modules, broadband

Autodiallers, phone line, 3g/GPRStransmission modules, broadband

Illustrative list of products/services linked to sections in NHS PASA framework

Integrated Telecare

Telecare and Telehealth Agenda• ‘Building Telecare in England’ (July 2005)• White Paper - ‘Our health, our care, our say’ (Jan 2006)• Putting People First Concordat (Dec 2007)• Prime Minister’s Statement on the NHS (Jan 2008)• Transforming Social Care – LAC (2008)1 (Jan 2008)• Joint Strategic Needs Assessment, Local Area Agreements• Integrated and partnership working including pooled funds• Demographic factors and demand forecasting, predictive models• World class commissioning, whole systems approaches• Better procurement, performance management and VFM• Telecare and telehealth as mainstream service options• User choice, independence and consultation through direct

payments, personal budgets, self care and self assessment,preventative services, Supporting People

• Standards – interoperability, connectivity, electronic records• Workforce design, education and training

Section 3.3 “…… Person

centred planning and self

directed support to become

mainstream and define

individually tailored support

packages. Telecare to be

viewed as integral not

marginal……”

December 2007

•Whole population not solely those with identified

needs

•Embedding telecare in care pathways,

commissioning documents, specifications, contracts

•Choice, options and capacity in the marketplace

•Housing for an ageing population

•Independent advice, guidance and brokerage

•Transforming community equipment/retail

model/range of technologies and adaptations

•Added value eg enhanced home care and housing

with care, support for dementia, long term conditions

•Marketing services directly to users and carers

•Costing and charging, personal budgets, service

charges and other payments

•BT 21CN telephone and broadband switchover

“….So over the next few years we will give 100,000 people with long-termconditions the opportunity to manage their care in this way as 'expertpatients'. And during 2008 we will bring forward a patients' prospectus thatsets out how we will extend to all 15 million patients with a chronic or long-term condition access to a choice of 'active patient' or 'care at home'options -- clinically appropriate to them and supported by the NHS.

Real control and power for patients - supported by clinicians and carers.More than today's new choice of where and when you are treated, a newchoice tomorrow - in partnership with your clinician - about your treatmentitself.

Something made even more accessible by using NHS direct, the internetand digital TV as well as the telephone to improve support for patients whowant an active part in their care…..”

Gordon Brown, Prime Minister, January 2008

“…. Health Secretary Alan Johnson today launched an intense six monthdebate about the future shape of care and support services.

A rapidly ageing population means that in 20 years' time a quarter of theentire adult population will be over 65 and the number of people over 85will have doubled.

The growth in the number of people with care and support needs will puttremendous pressure both on services and on the financial support thatthey receive through benefits and other funding streams.

…. Today we are rolling out a £31million programme to test the potential ofinnovative technologies like telecare in supporting care for those withcomplex health and social care needs. Improving care with new scientificadvances and innovation is vital if the NHS is to continue to offer the verybest services, but this innovation must be at the frontline of the NHS tohelp people manage their conditions better themselves.”

Alan Johnson, Health Secretary, May 2008

Further Challenges• Human contact and technology, ethical and consent issues• Savings may accrue in health from a social care or housing

investment• Local authorities and their partners fail to plan for telecare and

telehealth• Poor engagement with users, carers, GPs, third sector and other

key stakeholders• Supporting People changes• Control centres, warden services and floating support• Inconclusive benefits for investments made• Focus on outcomes• Product and service innovation• Questions about the evidence base• Lack of a culture of joint/integrated/strategic commissioning

Evidence of progress• Survey information, telecare profiles and spend within the telecare

framework• Five events in 2008 covering outcomes, achievements and challenges –

qualitative information about progress• Better understanding of the best care pathways and the importance of

preventative as well as reactive approaches• White Paper LTC Demonstrator Sites commence – April 2008• Assisted Living Innovation Platform (ALIP) commenced Nov 2007 - part

of the work of the Technology Strategy Board• Headline issues on safer walking devices, home monitoring, long term

conditions, social care transformation and prevention• References in key policy documents• Academic reports, evaluations, journals• Wider initiatives on interoperability, standards, consumer products• Major global companies, expansion in Europe and North America etc

Number of new service Users aged 65 and over provided in 2006-07 with one ormore items of Telecare equipment in their own homes (or equivalent, such asextra care/warden housing). (2156)

April 2006 2006-07 Outturn

2.1OP026- 1. CASSR alone 59672 53761

2.1OP027- 2. CASSR in partnership with otheragency*

28114 29981

2.1OP028- 3. Other agencies without CSSRinput.

41462 65999

Telecare performance

Number of projected new service users aged 65 and over to be provided in2007-08 with one or more items of Telecare equipment in their own homes (orequivalent, such as extra care/warden housing). (2157)

April 20062007-08

projected

2.1OP029- 1. CASSR alone 81680 72419

2.1OP030- 2. CASSR in partnership with otheragency*

39894 39159

2.1OP031- 3. Other agencies without CSSRinput.

43698 49455

Telecare performance

2006-07Plan(as at

Spring2006)

2007/08Plan

(as at Spring2006)

2006/07Outturn

2007/08Projected

2.1OP032- Total plannedcouncil expenditure onTelecareinfrastructure.(2159)

£20,181,000 £21,247,000 £17,900,000 £26,666,000

2.1OP033- Total plannedcouncil expenditure onTelecare equipment andservice(2160)

£34,378,000 £49,581,000 £29,949,000 £57,574,000

Telecare performance

HEALTH

Social Care

Housing

Third sectorand others

Performance andsupport

Telecare Commissioning - AgendaIn your area, how many people……

Have dementia?

Have a long term neurological condition?

Fell at home in the last week?

Have angina, heart failure, diabetes?

Live alone with poor housing at risk of crime?

Have intensive home care, COPD and depression?

Attend A&E regularly?

Could be in a care home in the next year?

Could benefit from preventative support?

Could benefit from integrated telecare/telehealth services?

Examples of telecare implementation

www.icn.csip.org.uk/telecareoutcomes

Progress in Havering

• Two Extra Care Schemes in Havering:

• One with 33 flats and newest one with 64 flats

• Purpose built for Telecare, with:– Dedicated dementia wing

– 6 ICAT flats

– Separate day centre run by Age Concern.

• Telecare actively promoted amongst the residents bythe care provider, ICAT and Age Concern

• Bogus caller pilot with Met Police

• Mobile Support and Alarm Service for Older People

• Telehealth

Telecare In Surrey

= District and Boroughs with Control Centres = Monitored by Guildford BC = Monitored by Mole Valley DC

Mixed Package Case Study

• Harry, 79 years with visual, hearing &memory problems, history of falls andflooding incidents

• Lives with his daughter who doesn'thear him getting up early in morning

• Smoke & flood detectors + stand alonesolution:

Case Study - Bradford

Lady with Dementia

Family and neighbour concerned about night-timewandering

Lady not aware – thought she stayed in bed

Installed telecare system

Established clear picture of activity

Working with Community Mental Health team tomaintain her independence

CalderdaleLaunched service in November 2006

Around 200 Telecare solutions

Telecare - Falls strategy

Doing LTC pilot - Telehealth

Case Study Elderly lady with Downs Syndrome

Early signs of Dementia

Receives domiciliary support

Started wandering

Installed Exit Sensor

Link to social care who then can accompany her

Can assess any deterioration

Case Study - Leeds COPD Pilot with Leeds NHS Trust

Genesis units installed

Monitored by COPD nurse

Agreement to support other LTC’s

Telecare packages

Medication reminder Smoke detector Temperature Flood detector Bed sensor and light

Property exit sensor Gas detector Co Detector

Package 4 is for those who may be suffering from early signs of dementia. Thispackage incorporates heat extreme sensors, dangerous gas detection and theaddition if required of a door exit sensor to identify when a person may have left

their property.

• Vital signs monitoring for long term conditions

• Reduces the pressure on community matrons

• Able to send trend analysis to community matronsand GP’s

• Broad Green Hospital, Liverpool, for consultant tocheck and analyse

• Raised the awareness of Telecare to theCommunity Matrons

careprofs

Friends andfamily

Tele-carer

Care responseservice

Emergencyservices

NHSDirect

Careprofessionals

Home HubAppliance

Elderly livingindependently

Records

• NHS

• Social Care

• Housing

• Personal Health Record

Tele

health

Tele

care

Hom

eauto

mation

Cholesterolmonitor

Blood-pressure cuff

Pedometer

Glucosemeter

Sensornetworks

Medicationtracking

LightsDoors /WindowsMotion /ActivityBedKitchenBathroom

ServiceHub

Two years of progress

Key Messages• Technology is moving at a fast pace encompassing environmental

and individual sensor solutions together with smart hometechnology for an ageing population, this will impact on local andregional investments – identify strategic partners, plan carefully,commission and provide services for the future as well as thepresent

• Choice, personal budgets and self care as well as self-management of long term conditions will require innovativeapproaches from technology advice to monitoring and response –engage with stakeholders to identify their needs and respond withinnovative options and solutions

• Case studies for telecare are easy to find but evidence of overallcost-effectiveness is more difficult to establish – identify bestoutcomes for individuals and carers, monitor performance andcosts and demonstrate added value

Thank you for listeningCSIP would like to thank local authorities and theirpartners mentioned in this presentation

Housing & Telecare NetworksCare Services Improvement Partnership

Department of HealthWellington House135-155 Waterloo RoadLondonSE1 8UG

e-mail: telecare@csip.org.ukWebsite: www.icn.csip.org.uk/telecare