Trevor Drage, Assistive Technology Manager Adult Care and Support, in Cornwall, UK, chews over the issues of potential telecare clients who refuse the service and how to reduce refusal rates.
“No thanks, please give the equipment to someone who needs it”.
From time-to-time we have clients referred for telecare who would clearly benefit from it, but who decline the service. They have the right to do that, of course, but there is always the lingering doubt about why they would do so and whether we could have done more to sell (in the nicest possible way) the service to them.
First, is it possible that they do not understand what the service is about and the equipment involved? It is all too easy to slip into using technical terms and product names which have no meaning at all to the person. Where possible, taking equipment to the assessment improves understanding and also allows the assessor to check that, for example, where a pendant is required the person is able to press the button.
The value of professional and personable assessors cannot be underestimated in these situations. We are all too frequently one of many services talking to people and families at a time of great change and worry. Taking time to understand the individual and their situation will not be time wasted. The assessment is about them and not the equipment.
Involving family and trusted friends can reassure the individual and sometimes a clearer picture of the situation emerges. How many times has a telecare service been turned down because the customer is concerned about disturbing family and friends and being a burden? (Currently in Cornwall we are reliant on family and friends for response.) By involving family they can allay these fears and state their own concerns that if telecare is not installed they do not have the reassurance that everything is ok.
Sometimes refusal is cost related, particularly when considering a telecare package that includes additional sensors. It may be appropriate to reduce the telecare package which could reduce the effectiveness of the safety net it provides, but still reduces the risk that the individual lives with. However, cost is not always the key factor in declining the service: during the Whole System Demonstrator programme a significant number of people turned down the service, and it was free.
Perhaps it is completing the forms that is the concern: telecare application form; VAT exemption form; direct debit form; service contract, etc. It is likely too that these are not the only forms to be completed at the time telecare is required. So not only are simple, clear forms needed but the person may need support to complete them.
It’s not rocket science! Just simple steps that enable individuals to be supported to receive telecare where needed and not be declined because of not getting the basics right.
Trevor works for Adult Care and Support and can be contacted via tdrage@cornwall.gov.uk
Our experience also shows that some folk who could benefit are reluctant to subscribe because they see this as a loss of independence. Contrary to this perception are those that do have a system installed and realize that they have actually gained greater independence.
Cost is rarely a factor since we have a charity that will pick the cost in situations where the client cannot afford the service.
Trevor’s advice for improving uptake is really important because our research at CUHTec indicates that the refusal rate for telecare after full assessment and prescription is in the order of 40%; this seems relatively insensitive to the charges that a service user might need to pay.
This does indeed imply that the public remains sceptical or simply unaware of the benefits of telecare systems. Whilst some potential service users decline the telecare proposition as soon as it is offered, many allow the equipment to be installed (sometimes at considerable cost) only to ask for it to be removed the very next day, or perhaps within a week. This often follows a discussion with their relatives, who sometimes have perverse incentives in mind, including the idea that they might be offered free domicilliary care or residential care if they reject telecare.
The likelihood of rejection always seems to increase as the delay between assessment and telecare prescription and installation is extended.
It follows, therefore, that to Trevor’s list of steps, we should add:
1. A need to offer and install telecare as soon as a referral is received so that other (and perhaps dangerous) coping mechanisms aren’t found in the meantime.
2. Try to ensure that relatives are present when the care plan is discussed; this reduces the chances of misunderstandings and subsequent rejection, and
3. People will only begin to understand that traditional forms of care and support delivered on a one-to-one basis are unsustainable when they are told the full cost of this provision. The cost of residential care is now well known, and Personal Budgets will slowly help people to understand the full cost of personal care. Reablement services will play an important role in avoiding or delaying the need for help with domestic tasks, but only if they too make equipment and telecare a more important part of their provision.