Telecare Soapbox: A woman died of starvation and dehydration after her home care ceased. A question for telecare services (UK)

Editor Steve picks up on a sad situation and poses a question.

Mrs Foster was an 81-year-old Surrey woman with dementia who lived at home supported by visits from agency carers four times a day. This appears to have been a reasonable state of affairs until the UK Border Agency closed down the agency owing to allegations that they were employing illegal immigrants. The local council had been notified in advance so that it could put alternative arrangements in place for the agency’s clients but Mrs Foster seems to have slipped through the net. Unable to look after herself, she was left starving, dehydrated and without her medication. Nine days later she was found by a visiting nurse and admitted to hospital, where she died. Starved pensioner Gloria Foster died “with a total feeling of being lost” Surrey Comet.

We do not know yet if Mrs Foster had a pendant-type alarm or not but if she did she was obviously unable to use it. We can infer that she did not have any of the type of telecare that could have raised an alert passively. We can also work out that a system dependent on PIRs picking up movement would not have raised the alarm before she became immobile and may have been too late.

This story broke on the day when the UK media is preoccupied with the publication of the Francis Inquiry report into why NHS systems failed hundreds of patients who died from neglect in hospital. But how confident are we that flaws in our care systems are not contributing to the deaths of many people every day, unnoticed because the people are ‘invisible’ in the community?

It is organisational hubris to assume that everything will work properly, indefinitely. Systems fail in ways that cannot be anticipated because the failures that can be anticipated are the ones you take steps to prevent or mitigate. The right technology can make even the best systems – and how many care organisations have those? – more robust.

Every council, every social housing provider and everyone else with a responsibility to people living alone who are unable to look after themselves should now be asking what technology is available that will raise an alert if someone is unconscious or otherwise unable to raise an alarm when things go wrong. Technologies to do that have been available since before Telecare Aware started. Some are low-cost in comparison with ‘standard telecare packages’ so there is no excuse for them not to be more widely used.

The question is: What are you doing to make your systems more robust?

Categories: Soapbox.

Comments

  1. I’ve advocated for a very long time now that a simple proactive well being check for older people living alone is often a “life saver” and also often provides incredible valuable preventative data.

    This involves actually asking someone if they are okay, ensuring cognitive function and tracking changes/trends in that communication.

    Our own Alertacall service – now called http://www.OkEachDay.co.uk – has been available for over 8 years now and does this extremely well. It offers those who want it the option of once or twice daily contact from real people who care and those who don’t want that level of contact – the freedom to get on with their day. Everyone gets FREE medication and appointment reminders.

    Every single action is logged and tracked, there are no real holes for people to fall through. Our systems run from multi-redundant datacentres and are purpose built to do this beautifully.

    Interestingly, there is typically 50 to 100 times more “work” (signalling, communication) compared to a traditional alarm service, but yet our pricing is comparable or cheaper.

    Practically every single “rescue” we make is someone who had a panic button or pull cord alarm and could not activate it. Also, we often rescue people who were conscious but simply chose not to press a panic button because of personal pride.

    Incidents like that discussed in the article have been averted by OkEachDay many times, particularly when customers have come home from hospital and care packages and other forms of support have not been in place.

    Some housing providers are taking a proactive approach to these issues for example Poplar HARCA in London, an award winning housing provider has successfully used our service for several years to protect general needs residents with very high levels of success.

    Gradually, I hope more people will wake up from the “reactive” paradigm and move to a pro-active one that engages people.

    Regards

    James Batchelor
    http://www.OkEachDay.co.uk

    Inventor of the “I am okay” button

  2. Cathy

    I have just read six or so UK media reports on this death – whilst each contains the same quotes from the key people, they also vary in the details. I suspect there is a lot more to this than is being initially reported. In some accounts Ms Foster suffered dementia, in others she had had a stroke, in all of them it clearly refers to the agency staff as nurses rather than carers.

    I am intrigued that she was discovered by a District Nurse who just happened to pop round … so maybe the Council were not the key contact – perhaps the NHS should have been involved too … but in my experience district nurses do not just happen to turn up on people’s doorsteps – they attend because they are scheduled to do so and there should be a record of that in any care document in the person’s home. Nine days at least between district nurse visits seems a big gap so had nurses turned up and left without seeing Ms Foster for some reason?

    I have to ask whether her needs were being adequately met through just four short care visits a day if she spent most of her time dozing; supporting people to remain independently at home for as long as possible needs regular reviews and it sounds as if that was overdue before the agency was raided.

    Whatever the failures in the systems, does this confused picture of who should have been responsible for assessing for replacement services, not highlight just how fractured our care systems are? and then we wonder why assistive technology is not being used effectively?

    Yes Steve, the technology should be being considered in all such cases, but until we sort out the care system that provides the support and commissions the assistive technology we are applying sticking plasters! I used that analogy earlier today in another comment – but the root here is the same. Politics has no place in our care system and it is time that everyone involved in providing care supports started talking to each other and stopped worrying about who’s budget will take the hit.

    Ms Foster did not need to know whether the cost of her care was paid for by the local authority or the NHS, she simply should have had the right as a human being, to be provided with the care, dignity and support that she needed.

  3. Steve Hards, Editor

    @ James: Do you think we could get confirmation of your claims by way of a comment from Poplar HARCA or another client organisation?

    @ Cathy, I was aware of the points you mention about the articles quoting the same sources and not being consistent in the details, which is why I chose to link to the one I did which gives a slightly more rounded picture of Mrs Foster.

    What struck me was the similarity of the knee-jerk reaction official quotes and the ones we keep seeing in relation to the hospital-based failures of care. “We must make sure it doesn’t happen again”, “lessons will be learned”, and so on.

    Like the relatives of the people who died in Staffordshire I wonder if anyone will be held to account for system failures rather than what usually happens, which is to find an individual nurse or carer – someone who isn’t in a position to change the system – to blame.

  4. Jo

    If this lady’s needs (and the risks associated with living on her own) had been properly assessed then she might well have been offered a telecare packaged that alerted someone to her problem on this day. Whilst a proactive calling system would have prevented this disaster in some people, there’s nothing to say that this lady could have coped with performing a particular act every day to confirm that she was ok.
    The automated call approach is going to be a low-cost intervention that may be appropriate for some people whose needs are quite low, but may not be right for many with more complex needs. As others have already commented, telecare services will only work when the plan is complete – and that includes response and escalation.

  5. UNATTR

    She may not have had a fixed telephone line. She may have ran up debts and until they were paid she could not have a landline. So all your Telecare and call systems wouldn’t have helped this lady as she could not have them. Could she have had a GSM alert? Would she have been offered one? Would she have paid for it? Maybe she was properly assessed and maybe these solutions were offered but she said no I am fine thanks. Were her best interests looked into? Were advocates available to help in the decision making?

    All of the above shows the limitations of the services and the funding. One thing that will show up is the issue of long term care needs and the assessing of technology to address some of these needs. Contingency plans as part of a care plan that include technology as the main failure in these services is people.

    She probably will have had a pendant alarm but for some reason or other was unable or unwilling to press it – but will this case be looked at (inquest?) closely enough to suggest these sort of required outcomes? I doubt it due to the lack of knowledge of these systems (STILL) and their usefulness.

  6. > “there’s nothing to say that this lady could have coped with performing a particular act every day to confirm that she was ok.”

    You’re right, about 2 people per hundred living in their own home can’t engage with an I am okay button. But you know what happens when they don’t press it – or their carer can’t press it? Someone who CARES rings them up and checks they’re okay. If that person needs ringing up every day, that’s absolutely fine isn’t it. If they don’t answer, someone who cares can find out what’s going on inside a “real system” with real controls.

    I do worry that the goal of a lot of telecare is to remove contact from people, our view here is that it should be about empowering people and giving them control. Automation should be used to enhance CARE, not remove it. The people who want to fully engage most days can simply allow more time to be spent with those who cannot, that’s our view.

    > “The automated call approach is going to be a low-cost intervention that may be appropriate for some people whose needs are quite low, but may not be right for many with more complex needs.”

    I am sure you are not suggesting this and it wasn’t directed at us, but just for the record we believe using an inbound automated call to check on someone’s well-being is “disaster” for a typical older person. We do not do this, please be clear about that, what we do is put people in control, using an I am okay button, over how much real human contact they get, there’s a very big difference. What we do actually works!

    > “As others have already commented, telecare services will only work when the plan is complete – and that includes response and escalation.”

    Absolutely right, hopefully in the meantime those of us who provide these kinds of services can do everything they can and go beyond the call of duty to look after the interests of their users. I know this is the case of most telecare providers, but I also have come across alarm receiving companies (now presenting themselves as teleCARE providers) who are alarmingly apathetic about filling in these gaps. TeleCARE. You’ve got to CARE, your staff have all got to care, every part of the chain needs to care.

    > UNATTR “Maybe she was properly assessed and maybe these solutions were offered but she said no I am fine thanks

    This is a really important point UNATTR and there are a whole load of contentious issues around it. The telecare industry, in my opinion, is strangely lacking in marketing expertise. Yes MARKETING. Marketing is not a dirty word – it’s about presenting products and services in such a way that the potential beneficiaries understand the most relevant benefits to them, this wildly increases adoption which is generally in the best interests of absolutely everyone in the chain. This lady might well have said no to having some kind of technology that could have prevented this from happening, but even if someone out there *knew it could* it is unlikely they had the skill or time to invest in helping this woman understand why it would have been a good idea. So it was left. “Oh if she doesn’t want it, she doesn’t want it – let’s leave it”. This “leave it” view is actually (and I appreciate this is contentious) a negligent position to take in my opinion, as a telecare provider you should be bound to the idea that your technology can and should help people who don’t instantly recognise it can help them. This is not to say you should foist stuff on people who don’t want it, but you know what, adoption rates are *impressively high* if you are willing to spend just a little time talking to people and understand their needs.

    Getting off topic now, but someone’s just brought me a coffee, so why not keep writing… Of course I have a vested interest in our product/service (www.OkEachDay.co.uk) but why did I invent it? It sure as hell wasn’t to make money, telecare is one of the most difficult industries to be in. Full stop. I’ve set up several businesses. The effort to start a telecare company and make it a success is utterly insane. You could almost do anything else and make more money. This is an important point actually, the smaller “independent” telecare providers, the Docobo’s, Just Checking’s, Eldercare’s, Halliday James’ and so on – well, why do they exist? It’s because the people who set them up or now own them really give a damn about the outcomes, and in most cases their own personal outcomes are glued to the outcomes of their businesses.

    They were created out of a passion for something. They’re driven by people who really care, and probably will go the extra mile. When a company exists purely for the benefit of hedge fund managers and venture capitalists, then, really are you going to have the same culture of caring? Maybe, maybe not. I wish I could be confident. That said, it can be difficult for buyers to work out who can be trusted and not (just look at the care company that was providing care to the woman in the article in the first place) – but really, any amount of due diligence would have probably picked that up.

    Last point, and again, sorry to sound like a walking advert, but a lot of these issues, around people being left without care, in desperate circumstances, irrespective of what other agencies are doing, irrespective of all the rhetoric around “joined up thinking” – could be mitigated against with one simple thing, regular daily contact with people. It’s simple.

    Regards

    James

  7. UNATTR

    I could listen to you all day James but unfortunately our ‘bringers of coffee’ have all gone in the cuts and the reshuffles of departments.

    As a business your staff can quite happily push the boundaries and realms of reality in order to sell your product. That is a contract between yourselves and the customer. When LA, NHS, SME, Care Trust staff assess someone as needing certain services and devices they generally go to the far ends of the Earth to make people see the benefits – very rarely have I ever come across someone who has said ‘she doesn’t want it, let’s leave it’. It is in fact an insult to any worker, carer, assessor or other who has tried in vain to help someone see the benefits of these offerings. Cost, stubbornness, pride, reluctance to accept, refusal to believe, fear of someone thinking they cannot cope and that slippery slide into the residential, nursing and finally lonely death in unfamiliar surroundings all stop people from seeing the benefits for themselves.

    Some overweight people don’t go on a diet until they have a heart attack, some smokers don’t stop until they have a stroke or develop a COPD, some home owners don’t get a security alarm until after they have been burgled. These are all facts of our population. Using words like ‘negligent’ is dangerous. The daughter who sees the benefit of a pendant alarm but whose 86 year old dad refuses to have it because ‘that is for old people’ who subsequently falls in his house and dies of a fat embolism that could have been prevented if he had been found hours earlier than he had been – should she feel negligent? Or are we just saying staff? If we are, why? What’s the difference? The staff is better informed? Why? I bought a new TV last year and I studied the model before going into the shop and speaking to a member of staff about it. I knew more than the member of staff. Were they negligent? No. Did they try to help? Yes. Could they have helped more? Possibly.

    You want to train RGNs, Social Workers, Domiciliary Care Workers, Auxiliary Nurses, Community Matrons, Care Coordinators in Marketing? No of course you don’t. But you want them to be as informed as possible. Telling them they are negligent if they fail to provide the appropriate ‘sell’ will most definitely provide you with some of the quickest and probably easiest to understand feedback you will have ever have had the opportunity to collect and collate.

    Also, one final business tip from a person that does not run several businesses, don’t p*ss off the very people that you want to promote your product. The very promoters that don’t get commission or any other reward apart from that of trying to help.

  8. Cathy

    [quote]You’re right, about 2 people per hundred living in their own home can’t engage with an I am okay button. [/quote]
    I think what you are saying is that 2 out of every hundred people who get your service turn out not to be able to engage? there will be many others who have not been signed up for your service because family or carers know they would struggle.
    [quote]… but really, any amount of due diligence would have probably picked that up.[/quote]
    Many families would not know where to start with due diligence James, and nor should they have to. Having said that the press reports say that the agency staff provided good care.

    [quote]… could be mitigated against with one simple thing, regular daily contact with people. It’s simple.[/quote]
    Yes James it is simple – and yet, across the whole of the UK it is not consistently happening. Popping a sticking plaster on by giving these very vulnerable people, an I’m Okay Button is not going to resolve the situation. Your product is no doubt a very good, very welcome addition to some people’s lives and then there are people for whom it would offer no benefit.

    [quote]I bought a new TV last year …[/quote]
    I was privy to the delivery of Evelyn’s new TV on Tuesday. Her friends have persuaded her to buy a new one because the sound had gone on the old one.

    So this sleek Lamborghini of a TV arrived with two very professional young men. They were efficient, had the thing tuned in in no time, and they were very patient with Evelyn.

    All was going well until the younger one started to instruct Evelyn in using the remote control … not his fault but he didn’t understand how to communicate to take account of her hearing impairment and he started with explaining the HD channels.

    Evelyn does not know what the HD stuff is she just wants a TV picture and subtitles in English. Then we got to the fact there is no on/off button – or rather there is but it is inaccessible at the back so Evelyn was instructed to use the remote control and how the on/off worked.

    I discreetly got a run through of the essential buttons on the remote so I could reiterate it for Evelyn before I left (and just in case she rang me in the wee small hours in a panic). I was impressed that the remote had nice sized and clearly marked buttons. Evelyn is an intelligent woman but she needs time to adjust to change and she needs communication to suit her. Is the shop negligent for selling her an all singing all dancing HD TV? no of course it isn’t.

    Why do I share this? because it highlights that people can be easily persuaded to do things which are not necessarily in their best interests; since Evelyn doesn’t have the sound on and uses the subtitles the old TV was still perfectly fit for purpose.

    Evelyn had no need to spend a ridiculous sum of money on a new TV with controls that will bamboozle her but she sees it as a way to ensure that those people who wanted her to have a TV with sound will still visit her because what she fears the most is living a lonely life. She begrudges having to buy her own mobility aid which she really does need and complains about the cost of her community alarm which has proved valuable to her and yet she will use her money to buy people’s company.

    When it is only me visiting with her the TV gets turned off and we have a conversation, which she really enjoys and I love to hear all about her youth and her dancing. Actually, because the TV was off I could hear that she sounded so breathless on Tuesday it did cross my mind she may not have long to enjoy the new TV. I spoke with her about that and gently encouraged her to see her doctor when she admitted feeling a little unwell.

    I could persuade her to get an I’m okay button – I can be very persuasive when I need to be – but I am not going to, not least because if you rang her and she couldn’t hear you she would shout at you down the phone and hang up – all good you would know she was okay but she would then be frustrated for the whole day about the nuisance call she had received.

    She has a Community Alarm and she does now use it reliably; she has visitors every day and two good neighbours who keep an eye out for her. She gets out most days on the bus to town for a coffee and then back home again on the bus and it is noticed when she misses the outing. She is most at risk when she is outside her home but she enjoys the social contact from going out. I would love to persuade her to carry a mobile phone and learn to text as well as use some GPS location system … so I would know she is safe and well but she would struggle with that addition to her life and the stress for her of remembering to charge it and carry it would be burdensome.

    In the meantime the one thing that is making her life miserable is being unable to get a move to sheltered housing because the Council say she that even though she is 84 she can competently do all the essential tasks of daily living.

    James what I am trying to show you is that technology is not the answer to every problem.

    [quote]Also, one final business tip from a person that does not run several businesses, don’t p*ss off the very people that you want to promote your product. The very promoters that don’t get commission or any other reward apart from that of trying to help.[/quote]
    @UNATTR 8) [i]note to Steve – I need a “hi-five” smilie please so I don’t risk saying nice things to UNATTR :lol: [/i]

  9. Hi UNATTR and Cathy

    I’m happy to be challenged – keeps us all sharp, right? So let me get this right. Am I being attacked because I’m saying that providers need to better understand how to talk about and market telecare to increase adoption (which benefits everyone)? Or is it because my wife who also works about 60 hours a week in this business brought me a coffee?

    I also may have been too passionate in my response. Let’s blame it on the effect of trying to write after another few exhausting weeks driving around the country responding to requests to demonstrate our systems.

    Let’s get the issue of “marketing” out of the way. Marketing is NOT a dirty word. Someone marketed everything you ever bought! No successful business, social or commercial, can make anyone properly engage with something they don’t want. What they can do is use marketing tools and skills to dramatically improve understanding of the benefits.

    The failure to understand this is one reason why so many telecare pilots don’t get traction and why the Whole Systems Demonstrator was so long in its early stages. It’s difficult enough to get someone to use a product they DO WANT sometimes, let alone to get someone to use something they associate actually with a loss of independence!

    I make no apology for asserting that a proper understanding of marketing principles and presentational techniques will make the work of occupational therapists, social workers and other front-line professionals much more effective. These are not skills taught in their training or acquired by accident and, far from not wanting to train “RGNs, Social Workers, Domiciliary Care Workers, Auxiliary Nurses, Community Matrons, Care Coordinators” in marketing – yes I do!

    I am actually sick and tired of offering those kinds of groups marketing guidance to help them create successful services and finding that most react negatively and consequently stumble along wondering why a good chunk of their telecare projects fall flat.

    I’ve offered to do this for almost every group of people I’ve met in the last 5 years. In fact, you get me 50 people together who want to come to a course on how to massively increase telecare adoption rates – £25 each (to cover venue and materials) – and I’ll spend a day with them. Ok? I think you’ll find the issue is that people don’t think they need it or that it’s somehow a yucky subject.

    >> Using words like ‘negligent’ is dangerous.

    No it isn’t, but I’m sorry if any frontline worker would take offence. Yes, these under-pressure and often worn out professionals make every effort in their power and experience to protect people. But what I’m talking about is negligence on behalf of the sector to face up to the kinds of things that need to be done to get this stuff to really fly. Which brings us back to “marketing” again – which is what 3ML is supposed to be all about, by the way! Is it evil to sell the benefits of some life saving technology? If staff are not willing to sell the benefits, adoption will be low. End of story. Move on.

    Cathy, I liked your response. I also mean exactly what I say about clients’ ability to engage with our service. E.g. we have a site with 140 older people, wide range of needs, and there is just 1 person who isn’t on the service because she is hardly there. The other 139 engage with it just fine. It’s normally a bit less than that and the 2% I said originally holds.

    As for Evelyn hypothetically finding a call from us a nuisance, may I respectfully say that you seem to be confusing our service with those who make automated calls to people at a certain time each day. We do not, precisely because we understand that such calls are a nuisance – and the one-month drop out rate of people who start using such a service is substantial. With our service the client initiates the contact with a simple button press at a time that suits them. The system monitors whether they have “checked in” and an appropriate escalation procedure kicks in ONLY if they fail to do so. Please check out the detail on our website

    >> James what I am trying to show you is that technology is not the answer to every problem.

    You have no need to “show me this” Cathy because that’s exactly what I’m advocating! In my opinion it’s CONTACT that matters and technology should be a conduit to contact or enhance it. If someone needs constant care they don’t need the well-being check aspect of our service and we don’t recommend it. But, the fact is, there are millions of people who don’t have that in place and http://www.OkEachDay.co.uk would be of real benefit to them.

    You know what, UNATTR and Cathy, I bet we would agree on a lot! We’re not so different really. I bet you care passionately about what you do and want as many people as possible to benefit from telecare as possible. We are the same in that respect I think.

    Regards

    James Batchelor
    http://www.OkEachDay.co.uk

    Inventor of the ‘I am okay’ button

  10. UNATTR

    It is this forum, and possibly this forum alone, that provides the leveller for strategists, industry and on the ground workers. Although at times it appears there is a small amount of industry bashing (unfair? no) what is in fact happening is the most honest and straight forward workshop you will ever get the privilege of being invited to/gatecrash.

    The level of information that can be garnered and gained within these virtual garden walls is immense and at the end of it the person in their home is the one who benefits (not necessarily the most, but definitely benefits).

    Take this thread for example. We are not having a go at Mr Batchelor, we are simply providing other points of view that he may or may not have taken into consideration previously. Industry is not the enemy and neither are the nurses, clinicians, social workers, tele-operatives etc. We are all here to do something – whether it is to provide a suitable product and make some money or whether it is to feel like you have done all you can to assist people; and not make money. Ba buum

    I really do appreciate this forum as it continually educates me and provides a very useful insight into the minds and worlds of its various contributors. The only thing I dislike is my inability to use my real name for fear of my masters interpreting my thoughts as representing theirs and the subsequent downfall of my mini empire. Not that it makes any difference because hopefully aside from the occassional late at night, not too thought out, comment that gets castrated by others anyway, my input is in some way as useful for others as their’s is to me.

    Cathy – you are right technology is not the solution to everything. You are also right when you say people can be overtechnowhelmed (I think you said that). You are equally (and finally) right when you say that we can use our immense skills and intimate knowledge of the person to sell them something they don’t want, don’t need, won’t use. But we don’t. And we don’t because that simply would not be right. Not right for us ‘cos that is not what we do’ and not right for the supplier because there is no proof in the pudding then and finally and most obviously not right for Ethel or Jim. That sort of ‘sell’ diminishes their trust in us and sometimes that is what we need to get through someone’s door to provide the help they really need. If we don’t get through the door, if the phone stops being answered then we are limited on what we can do.

    Mr Batchelor – yours is one product, one service. These days we are off our leashes and have the world at our feet in the many services, organisations, equipment providers and assistance we can provide/signpost/advise on for people trying to live at home as independently as possible. Yours would be 1% or 100% of the assistance we thought people may need. If the 1% is not seen as valuable by the person and we advise them to splash their cash on it then we have no chance with the other 99%.

    Your product is good at what it does and it has its place but do not for one minute think that every person who is older, vulnerable, disabled or French needs it. That would be stereotyping with 5.1 Dolby Surround, a real big sub woofer and an Amstrad CPC464 keyboard sized mistake.

  11. Steve Hards, Editor

    Thanks for your kind and encouraging words about Telecare Aware, UNATTR. I’m pleased my initial Soapbox rant triggered off this discussion even if my original point about services looking to have ‘fail safe’ elements got rather lost :-)

    I should also say for readers that your last comment was written before you saw James’s last one as they were both queued for approval at the same time.

    As for a ‘Marketing for Telecare/Telehealth Service Managers’ seminar, I’d organise one – but would need to charge much more than £25 to make it viable!

    Steve

  12. UNATTR

    Apologies for writing so so much and for double posting. My last comment was put together probably around the same time as James’ was. Had I seen James’ response I would have used other words. Many other words.

    Your response has shown that you are a businessman through and through and that is not something I am saying you need to apologise for or be utterly ashamed of yourself of being. Plugging your service, so many times, offering to train staff in the principles of marketing (presentational skills are part of most professionals training but obviously not at the level you are talking about (a FULL day for £25) is just, well, wow.

    I just can’t understand why there isn’t a module in the nursing degree on marketing principles. I think you should suggest this to the RCN, NMC, GSCC, GMC and a few institutions of higher learning – wow.

    You are ‘sick and tired of offering marketing guidance’ and their lack of interest in your offering is the reason for their telecare projects failing. That’s where we have been going wrong all these years; I thought it was the fractured services, different budgets, impossible procurement procedures, lack of partnership engagement, industry over-promising/over selling but in fact we have the definitive answer. It is the staff not knowing their marketing principles. Wow.

    You have a site with 140 people on your, sorry I forget its name – you may need to mention it more – kit thing. I sincerely hope others see the issue with this and that I don’t need to spell it out too much. Each one of those 140 were assessed as needing this system were they? If the ‘site’ had 10000 people in residence then I would say that is fantastic and those people that have been assessed as needing it are benefitting from its reassurance and security. However what you have just demonstrated is 2006 and thinking. 2013 (even 2008) thinking is assessed for services. What a shot in the foot. Give me your individual user numbers – not those ‘put on it en masse’ and I will applaud your marketing principles and presentational skills and may pay you, say £25 to cover costs, to come and guru me.

    Oh and Negligent – you stated in your 2nd/3rd advertisement/comment that you meant the sector was negligent. It is just that maybe what you meant but it is not what you said. You quoted a worker’s remark and said that this was negligent (in your opinion). May be we are talking at cross purposes and the worker you refer to is in fact an employee within the industry who assesses need and provides the appropriate equipment. I have yet to meet an industry assessor who didn’t, miraculously, prescribe anybody else’s equipment aside from their own. These are not assessors; these are sales people.

    I do apologise for the coffee remark, it was pure jealousy.

  13. Cathy

    [quote]Am I being attacked because …[/quote]
    You are not being attacked – we are trying to share with you our experience of working with a wide cross section of people who may or may not benefit from your particular product

    [quote]I also may have been too passionate in my response. Let’s blame it on the effect of trying to write [u]after another few exhausting weeks driving around the country responding to requests to demonstrate our systems.[/u][/quote]
    There is nothing wrong with being passionate about this … I am certainly passionate that people should be able to choose assistive technology as a care support if they wish to do so – but I am equally passionate that it has to be informed choice about both the product and the service – which is not always either offered nor easy in the current climate.

    The I am passionate that the product or service has to be incorporated into a holistic approach and has to do what it says it will do

    I have underlined a little of your quote – with respect it is this kind of statement that gets people’s backs up … we do not doubt that you and your wife are working hard to deliver a product and service you believe in … but you find an opportunity to remind us of this in almost every paragraph … not attacking you – making you aware that you do something that is causing a reaction you then don’t understand (we all do it – so please accept a Johari Window revelation with the spirit in which it is offered?)

    [quote]Let’s get the issue of “marketing” out of the way. Marketing is NOT a dirty word.[/quote]
    I have no problem with marketing – I am frequently critical of the poor marketing I see in the sector but it is the quality not the practice I am questioning BUT before we get heavy on the marketing we need saturated education. The public need to understand the bigger picture of assistive technology so when you market your product and Tunstall or Possum market theirs, people have a chance to make an informed choice.

    [quote]I make no apology for asserting that a proper understanding of marketing principles and presentational techniques …[/quote]
    The problem is they are busy doing their day job. Let us turn this on its head – are you trained in OT and nursing and social work and … and … and …

    [quote]Cathy, I liked your response. I also mean exactly what I say about clients’ ability to engage with our service. E.g. we have a site with 140 older people, wide range of needs, and there is just 1 person who isn’t on the service because she is hardly there. The other 139 engage with it just fine. It’s normally a bit less than that and the 2% I said originally holds.[/quote]
    okay so that is 140 people – what about the 6,000 others that live in that town – you have no idea what percentage of them could engage.

    [quote]As for Evelyn hypothetically finding a call from us a nuisance, … With our service the client initiates the contact with a simple button press at a time that suits them. The system monitors whether they have “checked in” and an appropriate escalation procedure kicks in ONLY if they fail to do so. [/quote]
    That is exactly the scenario I am describing – she would forget to check in – she has other things on her mind and she doesn’t like communication technology because of her hearing impairment. It wouldn’t matter that she was only pressing a button it is a type of technology that she is fearful of.

    This is an example of where I or UNATTR or Jo might have far more detailed knowledge of someone and start from their needs BEFORE we slot a product/service into the frame. We are starting from a different place to you and your product might be one of several possible outcomes … it is like the old joke “please can you tell me how I get to Tipperary?” “well to be sure I wouldn’t start from here”

    {quote] James what I am trying to show you is that technology is not the answer to every problem.

    You have no need to “show me this” Cathy because that’s exactly what I’m advocating![/quote]
    but the contact you are advocating is using a piece of technology …

    [quote]You know what, UNATTR and Cathy, I bet we would agree on a lot! We’re not so different really. I bet you care passionately about what you do and want as many people as possible to benefit from telecare as possible. We are the same in that respect I think.[/quote]
    I don’t think either of us would disagree …

    and I don’t think we would disagree you have a great product, backed up by a great service and you can market it …

    what I think we agree on is we would ask you to take a look at the even bigger picture than you already do.

  14. Jo

    Although this is a fascinating discussion, my concern is that we are forgetting that a couple of important points:
    1. how do we protect against system failure for vulnerable people who can’t or wont do what we want them to do? and
    2. how do ensure that telecare services don’t end up in the dock in coroner’s court because of a failure in the assessment, installation, monitoring or response elements of that service?

    The first implies that we need a lot of redundancy so that if something goes wrong something else will come into play and ensure a safe outcome. As we push for more people with more complex needs to be included within the community schemes then we definitely have to abandon the “one size fits all” approach – and this means no block contracts whether they are for social alarms or for automated calling telephone systems. Sorry, I came across so many of these “I’m OK” services in the States that sounded so much like your service but which failed because most people didn’t like them, that I am not surprised that this simple approach hasn’t caught on here where lots of people simply don’t like having to do things to suit a system.
    The second problem is one for the industry and, hopefully, with more training and a clarification of who’s at fault is something goes wrong, then the number of equipment errors will continue to decline. Of course, if we carry on trying to reduce the cost of installations by inviting services users and their families to install equipment for themselves, then perhaps we are asking for trouble. If this happens then the industry will face a very hard time dealing with the sort of newspaper headlines that would follow an inquest where the coroner identifies an equipment or installation failure.

  15. TI

    “I came across so many of these “I’m OK” services in the States that sounded so much like your service’

    In the last 12 months we have piloted Mr Batchelor’s service with hundreds of service users and gone through extensive due diligence. With some certainty I can tell you there is nothing like this available from anyone else and it’s quite sophisticated. There are, it would seem, plenty of ‘we will call you with an automated call’ type services but Okeachday works on a completely different idea which we feel is quite empowering for users. We at least have had very positive feedback from groups where frankly we thought they would hate it, so that’s been quite interesting. On our schemes when freely offered 8-9 out of 10 people have requested it, which is high considering some of our residents are couples and have care packages in place.

    Do take him up on a visit if possible.

    TI

  16. Hi Folks

    This mantra about giving users personal choice is tiresome, not because it doesn’t have a lot of value (it does), but because it doesn’t reference other people who are involved with, pay for and have to pick up the pieces when something goes wrong.

    You have to differentiate between helping someone understand the benefits of telecare to improve adoption rates (and the support that lends to lots of people around them) and selling them a TV. They are not the same. It’s important for everyone that the system can “sell” the benefits of telecare Fred, 84 and counting.

    Also you are drawing *way* too many assumptions about what my/our motivations are and to some extent drawing too many assumptions about how our service is used. Just for the record:

    I’ve personally visited over 600 older people in their homes and sat/talked with them, we’ve donated huge amounts of our service to people who want the service but have no other means to pay for it. We write to our customers, befriend them and regularly go well, well beyond the call of duty to help them. You have no idea what the long term ambitions for this, which include the idea of charity incorporation and really shouldn’t speculate one bit.

    Cathy you said:

    > okay so that is 140 people – what about the 6,000 others that live in that town – you have no idea what percentage of them could engage.

    We have over 1000 users in that town alone, I am confident I know exactly what I am talking about when referring to our usage figures, you, with all due respect – you really do not.

    That said, you are welcome to come to my office and I’ll show you a more about what we do, just get in contact through one of our web sites.

    Final comment, in regards to Steve’s question posed to readers “What are you doing to make your systems more robust?” I still absolutely maintain that having a system in place to ensure contact people are ok each day is the simplest approach.

    Have a great weekend!

    Regards

    James

    http://www.OkEachDay.co.uk

    Inventor of the ‘I am okay’ button

  17. UNATTR

    TI – I am not quite sure from your comment whether the system is free to the user or whether they have to contribute towards it. Also is it offered to everybody or only those that you feel would benefit from it?

    The reasons I am asking are that cost makes a huge difference as to whether people take up some technologies or not and the appropriateness is one which plays a big part in whether we are providing the right solution.

  18. Jo

    James (and your service commissioners) – this is not about the technology and its inventors, nor what is available in the USA, Australia, Japan or Outer Mongolia. None of it is rocket science, nor should it be. This is about health, social care and housing professionals knowing enough about individuals, and the range of services that could be made available to them, to appreciate the importance of matching individuals to the particular telecare service that is right for them. Undoubtedly, the simplest is best – but only for those whose needs are not complicated by memory, sensory, cognitive or behavioural issues. The importance of having lots of options available is obvious to me – as is the fact that many people that I feel might be vulnerable may not themselves feel that they are vulnerable, and might also not be classified as vulnerable by social services or other professionals.
    It’s pretty clear that we in the UK use some pretty poor catch-all definitions of vulnerable including, for example, anyone aged over 75 and anyone who lives in sheltered (or social) housing.
    If we believe that there are nearly 2 million people receiving some form of telecare services (including basic community alarms and automated check-calls), how many of them have been assessed as being critical or substantial in terms of risk – 20%, 25%? The remainder are moderate or low – so these services are either preventive or they are simply being provided to the wrong people perhaps because of their housing status as tenants. Give them the choice, and they might well select something inappropriate – or perhaps to keep the pennies for themselves!
    All we can do as professionals is to gather as much information on people as we can, and recommend the service that we believe is best for them as individuals. The services themselves should have certain safeguards (why else have codes of practice?) and, as the industry matures, commissioners should learn to extend these safeguards to tackle more and more of the “what if?” questions. Ultimately, people’s own choices can leave them exposed. We can try to convince them of the risks, and put in place safeguards where possible – but at the end of the day, a life without risk may not be worth living.

  19. Cathy

    [quote]We have over 1000 users in that town alone, [b]I am confident I know exactly what I am talking about when referring to our usage figures, you, with all due respect – you really do not.[/b][/quote]
    No James I do not know your ‘system population’ at all – not one of them – but you ONLY know your ‘system population’ which is why I am saying that you cannot possibly have figures to show that only 2% of the entire population cannot engage with your system; that is what you stated in response to Jo originally.

    You do not know what the remainder of the population would/would not do – only the population who have have ever had your system installed.

    [quote]This mantra about giving users personal choice is tiresome, not because it doesn’t have a lot of value (it does), but because it doesn’t reference other people who are involved with, pay for and have to pick up the pieces when something goes wrong.[/quote]
    With respect James I don’t think you understand informed choice.

    I choose to go hill walking, I take sensible precautions like carrying a map and compass as well as first aid gear for me and two dogs. Are you saying that I shouldn’t do that in case a freak wave comes in off the Atlantic, sweeps me into the North Sea and the Lifeboat has to be called out? I mean what are the chances of a wave crossing the entire UK landmass and still being able to carry me into the sea? (answers on the back of an envelope and my body mass is not a relevant factor! :lol: )

    In engineering terms drainage and sewerage systems are designed against the notion of the 100 year storm – not a hundred years of storms but that one storm that statistically should only happen once every hundred years. Of course it is no guarantee and there might be 2 of them in any 100 year period. In terms of computers and telecoms we have the concept of ‘Nines’ reliability [url]http://en.wikipedia.org/wiki/Nines_(engineering)[/url] so we feel safe to get into a computer controlled airliner to go on our holidays?

    Unfortunately human evolution has not yet reached the point where we come with Five Nines stamped on our bottoms, sometimes our wiring goes wrong and our valves leak. or we fall and break something or our brain is damaged by dementia. At what point James do we flawed humans stop having any right to choice in case it impacts on someone else?

    Jo I think that actually answers your question:

    We engineer the products and services to high standards such as Five Nines and that includes the business continuity or back up – not necessarily multiple layers of redundancy. We educate the public as well as professionals about what technology (generic AT) can do and then we allow people the informed choice of the solutions that would be best suited to their needs. Then we let people live their life because we each only have one and we should be enabled to make the best of it if we choose to do so.

    What we do not do is carry on with product/service providers telling us that Evelyn needs this or Evelyn should do that – because that is uninformed choice and it is when the disasters happen since us humans are the weak link and make mistakes.

    To take that back to Mrs Foster, undoubtedly somewhere in the inquest we will hear that there were a series of mistakes made, each of which on its own would have been a weakness in her care but not necessarily led to her death. However, joined together they resulted in her abandonment and decline to a point were she could not be saved. Mistakes happen but if we have resilient systems mistakes get snagged before they join together to become critical incidents.

  20. “you cannot possibly have figures to show that only 2% of the entire population cannot engage with your system”

    Of course we can, within certain degrees of tolerance. Even relatively small samples of the population scale in an amazingly linear fashion. Otherwise what is the point of any research, trialling or gathering of any statistical data? I will qualify my figure with a caveat that this excludes Asian communities – these are an unknown for the moment. We do have plenty of older Asian customers, but that’s the main group we haven’t actively approached, piloted and researched, though that will change this year. My expectation is that demand for our kind of services will be lower in Asian communities because of family structure and other value systems that operate. They’re probably doing their own daily contact, which is great.

    “I don’t think you understand informed choice.”

    I think you’ll find I do understand perfectly well. It’s an understanding of informed personal choice that makes or breaks any project/business/venture requiring other people to be involved.

    Let’s take the sewer system as an example of informed choice in action. It took a long time for every dwelling in cities to become connected and I hazard a guess that for a very long time many people were rejecting the idea of it because they were quite happy to continue throwing their crap out the window. Were they not making an informed choice in the circumstances? Doing that had a direct effect on everyone else and in time, as the benefits of the sewer system became clear, the majority of people made the informed choice of wanting their dwellings to be part of it. The requirement to be connected became enshrined in legislation and now you have no choice, informed or otherwise.

    My point is that “informed choice” varies at any point in time. Whose information is it based on, and whose choice is it? Bearing in mind that it’s profoundly difficult to make someone use something they don’t want to use, as we see from the low actual usage of pendant alarms by those provided with them, at what point should the individual’s choice (especially if it is ill-informed) be trumped by choices in favour of the greater good?

    If for example, a housing provider knows that by implementing a specific telecare system in their properties it brings about a wide range of benefits to the group as a whole, and to them as an organisation, then they should do everything in their power to make sure the benefits of the system are understood by the group to improve adoption. If a local authority has reason to believe the implementation of a system could yield significant benefits for the community, they should do everything they can to increase adoption.

    At the moment, it seems to me, local authorities believe that telecare has significant benefits but what has been the quality of their efforts to promote them? If individual staff are not even conveying a fraction of the benefits in a skilled and professional manner then it’s going to be hard work. If you are scared that changing this might lead people to have telecare they don’t want or need (i.e. if you don’t trust the OTs, social workers, telecare providers) then you’ll end up with another problem – individuals and communities that could be gaining the rewards and not doing so, failed telecare projects and a lack of progress.

    And for what it’s worth again, I believe that a system for ensuring simple daily contact with older people, whether that’s managed between people without any technology whatsoever or through a system like ours could yields lots of benefits, like for example saving the life of the woman in the story.

    Do I say that because it’s in my commercial interests to say it? No. (Though it is) I say it because I believe it – and that’s why we’ve spent the last 8 years working on a solution.

    Do I believe an overwhelming majority of older people living on their own would benefit from it? Yes I do. Do I believe that everyone would benefit from it, no I don’t. Do I think there are other solutions that might be better suited to some people? Sure. However, pound-for-pound, penny-for-penny, I believe a system like ours (or any system based on daily contact with REAL PEOPLE which is what we offer) could fix more problems and offer more real benefits, to more people, than anything else out there at this time. I am confident of this because I know what we do.

    Regards

    James

  21. Steve Hards, Editor

    Right, I’m now going to declare this discussion closed!

    I think that James, Cathy, UNATTR and Jo have had more than a fair crack at the issues around choice – and at each other along the way – and I suspect that none of them would let any of the others have the last word, so I’m having it!

    When I wrote the initial Soapbox, all(!) I had in mind was the tendency of systems to fail in unanticipated ways. A few recent examples spring to mind: banking; Mid Staffs Hospital, and now, in the UK, the system of processed food production. Sometimes failures are technological but most often they are due to a system which generally works but which then comes under severe financial pressure.

    We know that the organisations that run telecare and telehealth services in the UK are about to come under even more financial pressure than they already are, so we can expect that there will be unanticipated failures. And I think that my question of fail-safe in community care systems is still out there…

    If anyone has further issues they want to discuss, please write a fresh Soapbox item.

    Thanks all!

    Steve

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