The TSA Conference 2009 report of exhibitors

The Telecare Services Association Conference 2009, Hilton London Metropole Hotel - Report of Exhibitors

Although there were loads of excellent people presenting their wares at the Conference certain ones were found by the author to warrant considerable attention.

The NEAT dispersed alarm supplied by Possum

First up is the NEAT dispersed alarm that Possum had on their stall. Apart from the size and design quality/looks there are a number of excellent features that make this something to watch. Firstly the dispersed alarm unit is small and thin with three buttons which are clear. The unit has a voice unit which can pick up on someone calling for help and trigger an alert to the call centre (the round item in the middle of the picture with the red button on it). The other thing that I really like is the fact that the unit and each device provide a handshake. The handshake means that each device can communicate with the other devices in a smarter fashion as information can go bi-directionally. This opens many possibilities. The main possibility demonstrated to me was the fact that if a device fails by using a simple pendant you can easily find the failing device as the handshake will not occur, as demonstrated by a light on a pendant.

Another thing that I really liked was the fact that each device works in its own state. In this way the system can be a standalone system that can send an alert to the pager in the bottom right of the picture alerting the carer that the person is in difficulties. Any device can be set to do this without the need for the dispersed alarm. Furthermore the pager can be set to have a range of functions such as pass the alert to another pager or accept the alert. The most obvious benefit I can see for this is in supported living services where care staff might require extra help or the person themselves can start to use technology to enable a more independent lifestyle.

The other most important thing the NEAT system can do is to act as a wayfinding device to assist the user in maintaining independence. This can split the house into various zones and these zones can be defined by the practitioner or family or person. If you go out of zone then it is up to the practitioners or family to determine the best course of action. This is just the beginning of what this system can do so keep your eyes open for news on the NEAT system.

The Halliday James Stand

The Halliday James Ltd stall where Bernard Wignall demonstrated the excellent range of technologies that they have developed to support wayfinding. These include mobile phones, simple pendants with GPS and GSM capabilities as well as handheld units that have maps and so forth on them. What impressed me with this is the way in which the person using the technology was always at the forefront of all the design ideas and decisions. The two best products demonstrated were the HTC smartphone in the top of the table that can provide a decision support system for people with memory problems. This is very similar to the things I saw in the USA a few years ago but done better and clearer allowing user pictures to be integrated in to the demonstration and decision support software. Best of all for the first time I have seen a tool that meets my criteria for assisting someone to make a cup of tea. This is excellent!!!

The other standout item from Halliday James Ltd was the standard looking watch below the mapping device in the picture. This is a normal watch and could be the person’s own watch but the strap has a GPS/GSM unit built into the base – out of sight. Therefore the unit looks like normal watch but is actually as wayfinding device. Simple good design shining through again.

The Chubb Fall detector

The third company stall that had something standout to show was Chubb Community Care who finally produced two things I have been looking forward to, and they have been promising, for some time. The first is the new fall detector which as the picture shows is a wrist worn device. It looks like many other wrist worn devices and has a black emergency call button on it. In actual fact it looks just like a standard pendant on a wrist strap but actually is a fall detector that will detect ‘out of ordinary bumps’. “When a fall alarm is raised, the technology will vibrate immediately, during this period if the user does not want to send out the signal of the alarm, they just have to move their arm which will cancel the alarm. If this is not done then a call will be sent through the IntelliLink carephone or to the Carer Alert so the appropriate response can be sent”. Its not rocket science to see that this is fraught with potential possibilities for falls to be canceled as the person is crawling along the floor or some such activity that mimics the cancellation mode. But to their credit it is a well designed and well thought out piece of kit. If the person does decide to wave their arms in the air after a true fall and cancel the signal it can still be reactivated by pressing the black button. So a fail-safe is in place. I am looking forward to testing these out.

The Chubb Flexible Bed Occupancy sensor

Another thing by Chubb that I have been waiting for is the blue flexible mat that acts as a bed occupancy sensor (BOS). This is currently not to be found by me on their website. This is the mat shown above the standard BOS mat. The reason for this mat being exciting is that it can be used on pressure relieving mattresses which inflate and deflate. I am also pleased to see it connected to the new Chubb Bed Occupancy Monitor which enables personalised timing features so that these devices can finally be timed to meet the needs of the person.

This proves to be a valuable conference for many reasons. Not only is it the place to meet and touch base with the Telecare Gurus, but it is also the place to find out what the future direction for Telecare is to be. But for me, the best thing is to see how some manufacturers are still churning out the same things whilst others are beginning to see the true potential of listening to the people who use their devices.

Using Dependability Telecare Assessment to assess a piece of Telecare equipment

The Dependability Telecare Assessment tool (DTA) can also be used to assess a piece of Telecare equipment or service, either for a specific individual or to determine the dependability case for a device. In order to illustrate this a generic pill dispenser will be used. The pill dispenser has great interest to the author as it was one of the first dependability products he worked on many years ago whilst designing smart homes for older and disabled people.


A generic pill dispenser is a great idea, allowing a person to get timed alerts when medication is required. The pill dispenser provides an auditory and vibratory alert when medication time arrives.


Pill dispensers come in all shapes and sizes from simple Dosset boxes through to Telecare enabled pill dispensers that can alert the call centre if the alert is raised.


So let us consider whether a Telecare pill dispenser meets the DTA criteria (http://1.bp.blogspot.com/_ZFehjKEfwWc/Snv2JHtbU1I/AAAAAAAAADY/tBKUkgz4McA/s400/DTAbigger.jpg) :


Lets' start with the Fitness for purpose column:


Does the pill dispenser meet the broad needs of the person? Possibly it would in some cases. Many people require medication reminders so in many cases it meets this criterion. - Pass


Portability: The pill dispenser might fail on this as the alarm is cancelled by the movement from horizontal to vertical planes. - Fail


Comfort: This is really not applicable as it is not a worn device. – N/A


Timeliness: The pill dispenser should pass this as the alert is generated if the tablets are not taken at the appropriate time. This alert should continue for about one hour which is excellent. The call centre should also be alerted at the prescribed time after the alarm is activated. - Pass


Utility: Again, possibly another pass as the pill dispenser could well be useful to the person - Pass


Responsiveness: This is potentially where things can go wrong. Does the device produce the correct response? It alerts the call centre yes, but what then? What do the response centre do? Do they call the person or send someone out to check that the pills have been taken? Does the call centre need to be part of the equation or should the family or carers be responsible for the person taking the tablets? - Fail


And now lets consider the Trustworthiness column:


Can the person trust the technology to do what is required? Again another potential failure here. There are a number of issues that pertain to trust. The pill dispenser will act in a trustworthy manner by producing alerts at the correct time etc yet the system could fail the trustworthiness tests as pills could get stuck in the chambers; the chambers are too small for people on lots of tablets; who is going to fill the carousel up? What happens when a person takes the tablets out? – this last point is a critical point and leads on to the next Dependability criterion - Fail


Reliability: From experience of my nursing days and my years of working with older people what is clear is that people are distracted and this distraction factor can increase with age. The pill dispenser, does what it says on the packet: dispenses pills but there is no guarantee that the tablets are actually taken. Therefore the pill dispenser fails this criterion. - Fail


Safety: following on from the theme in reliability once the tablets are taken out of the dispenser there is no way to know the person has taken them. I have witnessed on many occasions that a person takes medication out of the dispenser, puts it in their pocket and goes to get a drink to swallow them. Now at this point people can get distracted. The glass of water needed to take the tablets might change to a cup of tea, a biscuit and settling down to watch the telly with the tablets still in the pocket. When the person goes to bed and is emptying their pockets they come across this stash of medication and could decide to take the days dosage in one go with the obvious consequences. So the pill dispenser fails this criterion. - Fail


Maintainability and Serviceability: Here the pass or fail is dependant on the provider’s perspective. The only maintainable parts the carousel trays, time-day discs and keys all of which could be lost and require replacing. The unit itself requires a service when the battery low level light indicates charging is required. This might require external intervention and an attached cost in some cases. – Pass and Fail


Let’s now turn to the Acceptability column:


Does the person find the Telecare an acceptable addition to their lifestyle? I think a definite pass here for most people. - Pass


Usability: - The carousel can be fiddly to fill for some people and requires a certain dexterity to tilt in order to obtain the medication, although a tilt helper can be purchased. The dispenser is also not light. Therefore I could consider this to be a Debateable Pass - Debateable Pass


Learnability: There is little for the recipient to learn but for the person filling the device, they have a lot to learn. The locking –unlocking; filling each tray with the appropriate dosage at the appropriate time etc. Depending on the skills of the filler this would be either a pass or fail; but some chemists might also fill the carousel for the person. Therefore I would consider this to be a pass. - Pass


Compatibility: The pill dispenser should be compatible with any lifeline equipment, requiring a simple protocol and frequency . - Pass

Finally lets address the last column


Adaptability and Aesthetics: Adaptability is not really an issue as the device is unlikely to change but aesthetically the design is in many cases excellent with clean lines. Pill dispensers also come in a range of one colour – white so that does not provide the person with a great choice. – Pass and Fail


So on reflection how does the pill dispenser fare? It received ninepasses and six fails and one indeterminate score; so on balance it could be argued that it passes overall. However, bear in mind these are dependability criteria and as such there should never be a failure. Moreover, the pill dispenser potentially fails all of the Trustworthiness criteria.


Using DTA as a methodology to assess equipment and devices is a simple process. It does not take many minute to think through whether something passes or fails if you follow the DTA tool (http://1.bp.blogspot.com/_ZFehjKEfwWc/Snv2JHtbU1I/AAAAAAAAADY/tBKUkgz4McA/s400/DTAbigger.jpg).


Conclusion


This example demonstrates the use of DTA in determining dependability of devices but what it also demonstrates is that the decision lies in the prescriber’s hands. The pill dispenser for example is a great piece of engineering and something that meets a definite need. Therefore the judgement call is whether the need is such that it out ways the lack of Trustworthiness highlighted through using DTA. I have no doubts that in there are many cases when it will be a very useful device, but perhaps its use will require a number of protocols and procedures to be written before installation. Furthermore the DTA tool highlights a number of areas of concern such as filling and responding to alerts and these will need to be resolved prior to use.

Supporting Carers through Standalone Telecare

The Problem
Mrs N is carer for her husband who has an acquired brain injury. As a result Mr N has reduced judgement and inability to understand that he is unable to support his own weight. He is unsafe getting out of bed and also unsafe getting out of his chair.

The Solution
A Voice Alert VA6000s (http://www.voicealert.com/) provided by Supra (www.keysafe.co.uk) was provided with the movement sensor beam narrowed. This was placed on the floor under the bed and wirelessly sends an alert to the receiver unit which is located in Mrs N’s bedroom. This movement sensor alerts Mrs N when her husband is getting out of bed. A chair sensor mat was also provided for the chair which works with the same unit and alerts Mrs N when her husband is trying to get out of the chair.

Rationale behind the solution based on DTA tool
The Voice Alert was ‘Fit for Purpose’ as it provides audible alerts to Mrs N which she can record in her own language. The Voice alert also allows different messages for each device connected to it so Mrs N can differentiate between her husband getting out of bed and getting out of the chair. The Receiver unit is portable and Mrs N can plug it in no matter what room she is in. The Chair mat can be sweaty so Mrs N had it placed under the cushion of the armchair. The alerts from the unit are instant with a minimal delay. Without the Technological intervention Mrs N would not be able to support her husband at home.

The Voice alert is ‘Trustworthy’ as it works every time as long as it is plugged in. It is safe and the only maintenance required is the change of battery for the peripheral sensors. Mrs N has a store of the Batteries just for this purpose.

The Voice Alert is ‘Acceptable’ as the unit allows Mr and Mrs N to maintain their lifestyle and independence. The receiver is usable as there are a number of voice alerts that can be recorded and the recording procedure is simple for Mrs N to do. There is little for Mrs N to learn apart from to turn the unit on and off and change the voice message and batteries. All components are compatible with each other as all provided by the same manufacturer.

Finally the Voice Alert is ‘Adaptable’ as it can be used on the chair and in the bed room. The sensor in the bedroom can be moved to the living room during the day so as Mr N improves he can walk around within certain areas but if he goes to somewhere he shouldn’t the alert will be triggered. In fact as Mr N improves the sensors can be used in whatever way Mrs N decides is best for her and her husband. Aesthetically the motion sensor looks a little unsightly as does the lead from the chair sensor mat that goes to the transmitter unit (placed under the chair) but Mrs N ensures that neither of these are in the direct line of sight for visitors or her husband who might get distressed if they were on full view.

DTA a working example - falls

DTA - an illustration of how it can be used

The problem
Mrs J has recently had a stroke which has left her with a weakness on one side. She has limited capacity to comprehend the consequences of this weakness and falls a lot whilst trying to do normal activities. She recently fell getting out of bed on the way to the toilet at night and also in the bathroom whilst getting off the toilet. Mrs J wants to be independent and feel safer whilst undertaking her daily routines.

The solution
Mrs J was given a bed occupancy sensor, pendant, pull cord in the toilet and a smoke alarm.

Rationale behind solution
This is a simple case in many ways, the main presenting issue is that of falls as a result of weakness resulting from the stroke. If we consider DTA we can see that we are meeting the dependability criteria by offering this solution.

(Click on Picture to make bigger)

The solutions provided are fit for purpose; they are portable, when necessary, comfortable, will work as expected in the appropriate manner and in the correct time. They are trustworthy as they are reliable, will promote safety and not cause danger and are simple to service and maintain. The solutions were acceptable to Mrs J who does not want to be bothered with technology but is happy to wear a pendant. The solutions are practical, require no learning apart from the pressing of the button on the pendant or pulling of the cord in the toilet; and the solutions are compatible as they are all provided from one manufacturer. Mrs J was concerned about the aesthetics of the pull cord but considered that her safety was of more importance than the look of the cord in the toilet and was happy that the placement of the cord was exactly right for her to use if she had difficulties in the toilet in the future.

This example ticks all the boxes for each product. The smoke detector was added as Mrs J could be compromised in the event of a fire in her home. She might fall whilst trying to vacate her house in an emergency situation. The replacement smoke detector replaces her current smoke detector but is positioned in the correct place in her hallway and provides an audible alert as well as alerting the response centre that there is a potential fire in Mrs J’s property.

ALIP

The Digital Access Project which is part of the Assisted Living Innovation platform ALIP have produced released the first of the demonstrations from a venture I worked on. It is available here. Currently only two videos are available but the scenarios are hopefully useful.

Some web publicity

I have recently featured in two ventures I am pleased to be part of one working with the UK consumer affairs magazine Which? and the other an interview with Hometoys Emagazine which is the smart home site. Versions of these are available on line:

The Which? article can be found at http://tinyurl.com/nqmhbv
The Hometoys piece can be found at http://tinyurl.com/l5aqs8 - Amended link sorry for the previous error.

More on DTA

I have finally done a small page on DTA the Dependability Telecare Assessment tool on my website http://tiny.cc/xe2bk. This expands on some of the material in this blog.