Jeremy Porteus, director of the Housing Learning and Improvement Network (LIN), addresses some of the more-frequently-asked questions regarding telecare in relation to funding, housing strategy, and infrastructure
I started the Housing LIN with a belief that when great people come together and share ideas, inspirational things happen. What has become apparent over the last few years is that person-centric, connected care, while widely regarded as the future of healthcare, remains a mystery to many.
With an increasing drive to develop new models of care that reduce the demand on more-costly services, we at the Housing LIN - in partnership with Tunstall Healthcare - have addressed some of the most-frequently-asked questions in a bid to eliminate any misconceptions and clear the way for the future of connected care.
Does telecare come under aids and adaptations budget?
According to the Department of Communities and Local Government, "the purpose of an adaptation is to modify disabling environments in order to restore or enable independent living, privacy, confidence and dignity for individuals and their families". This can involve the fitting of an additional rail to help climb the stairs, installing a stair lift, or the replacement of a bath with a level-access shower. Aids generally include door entry systems, environmental controls, and alarms; so telecare could be covered, but this will be dependent on the local organisation's policy. For example, the recent Department of Health circular sets out the allocations by council area for the £194m Disabled Facilities grants programme, administered through local Better Care Fund (BCF) arrangements.
How is telecare funded?
Telecare is funded in several ways - whether a home-owner or tenant - through the local authority means-tested eligibility criteria; the individual themselves or their families and informal carers via a personal budget; part funded through the council or housing association; and sometimes through various grant-making charities.
The strategy for your service should be to look at the 'end-to-end' service and work out the delivery model that is the most cost effective for your organisation.
Personal health budgets are also being introduced by the NHS, agreed upon by individuals and their local NHS teams. In addition, new local funding streams are now in place, including BCF overseen by councils and clinical commissioning groups (CCGs).
Telecare/telehealth needs to be mainstream before it becomes financially viable. Is this likely to happen in the near future?
There are a full range of solutions available; from free-to-download apps, and low-cost equipment such as dementia clocks; to very-expensive telehealth/televideo applications. You need to take into account the cost of the overall service. Buying individual ad hoc products and services from different organisations could make it a costly exercise. The strategy for your service should be to look at the 'end-to-end' service and work out the delivery model that is the most cost effective for your organisation.
Links to housing strategy
What is the offer for older people in relation to technology support?
If you are reviewing your housing and older people's strategy, it is important to ask yourself - how can technology maximise your housing with care/support offer, in terms of:
- Productivity - Staff can be deployed effectively; make good use of their time and feel empowered to better support individuals
- Efficiency - People can self-manage and health, care and support issues can be detected early, reducing admissions to hospitals and care homes or increased care packages and carer stress
- Outcomes - People can enjoy a greater quality of life, with increased independence and wellbeing, feel more in control and offer peace of mind
By 2020, nearly 100,000 more people will need to be cared for at home. Understanding what technology is available now and in the future is key when looking at your housing and older people's strategy.
How does technology meet my business objectives?
Firstly, you must clarify what your business objectives are and the problem you're seeking to solve. Consider whether they include things like:
- The need to provide more proactive, preventive services such as remote online consultations, medication support, 'I'm ok' services, activities of daily living support
- The need to provide social activities, befriending and digital inclusion support
- The need to provide homes that age with you, meeting the lifetime and lifestyles choices that people aspire to
- The need to report repairs and maintenance issues via an easy to use tablet or app
- Do your objectives also include social values such as reducing fuel poverty, creating resilient communities?
All these things are possible with new digital technology.
How safe is mobile/Wi-Fi?
The home of the future will be full of things that are IP enabled. This will transform the way information is provided and the speed information moves around.
When it comes to safety, it depends on what it is being used for. A back up, should the mobile signal or internet connection fail, is always required. However, if the solution is to check your blood pressure or weight twice a day and a late reading is not life critical, then the resilience needs to be less robust. So, predictive solutions, such as vital signs monitoring, rely on trend analysis to prevent crisis such as hospital admissions. Responsive solutions such as telecare require immediate attention to an event such as a fall or smoke detector activation. The data and transmission reliability question is different for each.
What models of care do we adopt and how can TECS help each one?
Ageing in place needs to be taken into account across all the categories below. Maximising the ability of people to be able to stay in their own home for as long as possible is key.
- General needs housing - typically 45% of households comprise of someone over 65 or with a long term condition - here we need to consider technology specifically for connecting people and early stage interventions
- Supported housing for older people - accounts for less than 5% of the market (729,818 units) - here we need proper risk assessments not only for physical and mental needs, but also for enabling individuals to stay safe and well for longer, utilising technology where appropriate
- Extra care housing - there is a significant shortfall of extra care housing in England. Our Strategic Housing for Older People Analysis Tool (or SHOP@) predicts a deficit of 61,000 units by 2030) - here needs based assessments to cover issues surrounding complex health needs, mobility, dementia, frailty, memory as well as enabling connectivity with others can be supported by telecare
- Specialist supported housing - more can be done to improve the way technology can support people with physical, sensory and cognitive impairments
What is IP and why is it good?
The home of the future will be full of things that are IP enabled - fridges, cooker, tablets, energy monitoring, mobile, home health hub, CCTV, remote access control. IP will transform the way information is provided and the speed information moves around. For example:
- It's always on - it works 24hrs a day seamlessly unlike analogue which requires dialing.
- It handles voice and data on the same network - something not possible with traditional analogue telephony systems
- It's fast - the data transmission speed is vastly improved and is virtually instantaneous
- It's adaptable - you can access a whole host of new services previously unavailable combined to meet your particular requirements
Rural areas - how reliant is IP/digital technology on the underlying broadband or mobile infrastructure which is currently challenging in a lot of rural areas?
The back-up tool is analogue until the broadband/mobile providers have 100% coverage. GSM can also be a good back up. Technology is coming along by leaps and bounds, but some of the systems are reliant on coverage. As a result, there will be some instances where one will have to tolerate a multi-level system until universal access is available.
Technology is coming along by leaps and bounds, but some of the systems are reliant on coverage. As a result, there will be some instances where one will have to tolerate a multi-level system until universal access is available
Interoperability - We have different systems in place from different providers. Are you working with other providers to link up the systems? Through IP will it be easier?
In the future there will be more 'bring your own devices' and services in the cloud. Over a fast period of time those protocols and issues will disappear. That whole approach will become obsolete in the next five years.
This blog first appeared as an online article in Building Better Healthcare on Thursday, 26 May 2016
With permission, reproduced on Monday, 6 June 2016 by the Housing LIN