Telecare Soapbox: What’s wrong with the UK’s model of telecare?

Telecare practitioner Rufus Handy articulates in a forthright manner what many people seem to be thinking about the way telecare is currently being presented and implemented.

Rufus has been a telecare co-ordinator for an English local authority for the past year. The opinions expressed here are his own and are not to be taken as representing those of his employer.

What’s wrong with the UK’s model of telecare?

For the purpose of this ‘soapbox’ item, which I hope will spark some debate, let’s just make the assumption that when an occupational therapists sees a client in their home situation, she or he acquires quite an accurate view of what the person’s actual needs are. To detractors of the occupational therapy profession, I’d say that this is what my experience has been, and I’ve often found that, as a result, instead of putting in telecare equipment, I’ve installed other pieces of assistive technology that have proved to be very useful.

In theory, telecare products sound great, but in reality they are just not effective. I was involved in a project to install telecare in a sheltered housing setting, using a well-known brand of equipment. We provided it to 70 people. The bed sensors, light controllers and fall detectors all had high rates of return by the clients. Specifically, belt-worn fall detectors were an example of an ineffective piece of equipment, and many authorities, including Durham, Kent, West Lothian have all reported problems with them, which I can confirm from my experience. Yet where are the improvements to this device which should have come the after all the years of negative feedback?

I also believe that the claims for the role of telecare in preventing acute hospital admission, reducing need for residential/nursing care, reducing the burden placed on carers, etc. have been considerably overstated.

As a result, the Preventative Technology Grant (PTG) has been being hijacked for widespread purchase of poorly conceived and designed second generation community alarm equipment at the expense of using other preventative technology equipment and simple pieces of equipment. A £5 ‘Magiplug’, for example, which prevents a flood by releasing water from the sink or bath, compared with a flood detector which costs £60, plus alarm base unit cost, plus monthly community alarm services cost, and which, when the device is placed on the floor, becomes a trip hazard and only alerts a call centre when a flood has already occurred and the damage is done.

Many local authorities now find themselves having spent their PTG funding on a stash of equipment that nobody wants, some of it having been returned by users.

Danger of a backlash

Local authorities, desperately seeking a panacea for the budget crisis in social care have been too eager to prove the telecare claims correct. Even the leading local authorities implementing telecare are struggling to justify the claims, admitting that the increased reassurance and peace of mind reported by users and their carers could well be the ‘Hawthorne effect’ i.e. the product of increased attention associated with being in a pilot study. This is view is backed up by the updated report of the Evidence Working Group of the Telecare Policy Collaborative (‘Building an Evidence Base for Successful Telecare Implementation’ November 2006) which also struggled to find any evidence to support the claims for telecare, commenting that the lack of use of control groups and reliance on anecdotal evidence suggested ‘trials could be overstating the benefits’.

While there is certainly a place for second generation community alarms that use sensors to monitor a home environment and which contribute to a person’s safety and security, it should not be the only form of preventative technology deployed. However, owing to the industry’s need to sell as much equipment as possible, that is how it is turning out.

There is a danger of a backlash (as seen with the story of the Cumberland district councillors criticising the county council’s spending plans in this area) which could result in the baby being thrown out with the bathwater. Such a backlash would lead to a social services culture in which the use of credible non-telecare assistive technology, and simple aids and equipment that do meet peoples needs, will struggle to survive. What a missed opportunity it is turning out to be!

Appropriate use?

By dishing out telecare kit to everybody regardless of need, places like West Lothian and Newham seem to imply that using telecare is appropriate for all scenarios. I think the recent life saved in Milton Keynes shows that there probably is a case for providing smoke and CO2 detectors that link to a community alarm service for older people, which is primarily what West Lothian did but, considering all the other factors involved in their situation, it is possibly a rather large leap to suggest that telecare was the thing that had such a significant impact on hospital usage.

Let us, as another example, consider Durham’s ‘People At Home and In Touch Project’, which has presented itself as a telecare success. I quote, as an example of the typical hyperbole that accompanies the claims for the benefits of telecare, “The County Council is at the cutting edge of piloting technologies that can help older people live more independently and safely in their own homes”. While Durham’s use of door exit sensors to mitigate the risk of people with dementia inappropriately leaving the house was a good early use of telecare, the majority of the equipment used was keysafes, which can hardly be considered as ‘cutting edge’ technology: 148 people received telecare equipment, of which 108 were key safes, 5 smoke alarms, 5 Carbon Monoxide detectors, 19 Door entry systems, 17 door exit sensors, 13 fall detectors, 2 pressure mats and 3 flashing light/vibrating alert. Claims that 1,783 residential care bed days were saved through the deployment of equipment and that people issued with door exit sensors were, on average, delayed from going into residential care by 6–8 months are difficult to believe when they are based on interviews with just 16 service users. In addition, the calculations of savings made were on telecare used versus the very worse case scenario — with no probability of the ‘very worse case scenario’ occurring.

What is the place for telecare equipment?

Despite my comments in this article, I do think there is a place for telecare, which is why I continue to work in the field. However, based on my first-hand experience of working with service users, practitioners and suppliers I am frustrated by what is happening.

The Department of Health, PASA, equipment suppliers, CSIP and local councils are all eager to view telecare as the cure all, which it clearly is not. There’s a role for it, but so much more we need to be doing, and my concern is that telecare has blinded many social services to those other things that can bring increased choice, much better value, and more benefits to the person.

If the main impact of telecare is, as the evaluations are beginning to suggest, that it provides psychological reassurance to people to make them feel more safe and secure, we should also be examining other ways in which we can do this that are more cost effective, and not just give out pendants or other equipment that most recipients are charged for and many do not use.

Services focused on people’s real needs would include providing robust, cost-effective, non-telecare technology and other possibilities, such as Pet Assisted Therapy to help people who are socially isolated and who have poor mental health. People who live alone want to know that someone knows that they are OK on a daily basis, so we should also be promoting self-install ‘safety confirmation services’ and ‘call buddy’ systems like those frequently found in the United States and now being piloted by Age Concern, where older people form telephone-based communities to check on each other.

In summary, I say that it is time that we all took stock, stopped regurgitating what the suppliers and CSIP are feeding to us, and develop some genuinely helpful services for people that meet their real needs.

Categories: Soapbox.