Thursday, 25 September 2008

The enablement and containment models

In telecare there are two main models: Enablement versus Containment

It is important to distinguish between the containment model and enablement model of telecare. The Containment Model contains older and disabled people by appearing to care about the person, but actually providing little support. This leads people to not challenge the status quo and accept substandard equipment and not challenge poor interventions. Technology is foisted on people using a spurious medical model which can be used to suggest that technology has pseudo-medical properties which it unlikely to have.

The Enablement Model strives to ensure people are personally enabled. Technological interventions are bespoke and tuned to the person’s actual needs and wishes. Technology rejection should decline and a person’s quality of life should increase as a result of these interventions. When developing a system it is important to consider that the telecare system must enable. From a strategic perspective this means that the telecare provider must be able to source from the best locations and not be confined or tied to specific providers. This, of course, means that things becomes a nightmare for standard purchasing agreements and official channels. It also means that the people who are undertaking the assessment for telecare are required to be trained to a higher specification than if they were limited to just one or two manufacturers.

Enablement extends beyond the user of telecare to also enabling the carers, allowing them to have breaks in care whilst still knowing the person they care for is safe. A person using telecare might be enabled to actually fully engage and challenge their environment through having the confidence derived from appropriate technology designed to assist them.

To exemplify this difference - Let's look at telecare self assessments, these produce a snapshot fast approach to assessing people for telecare. A self assessment will produce a more accurate picture of a person than simply providing a package of telecare based on a person having a certain condition or illness, but the self assessment cannot be more than a quick fix approach.

If we compare self-assessment with person-centred assessments then the enabling qualities of the latter become very clear. If we take the person-centred approach then we can provide telecare that meets the precise need of a person. By providing enabling telecare we are also having a cost-benefit to the person as well as the service providers.

If a person has the wrong telecare provision then there are a number of inefficiencies that have been documented and are apparent. Excessive calls to call centers mean people are tied up answering false alerts or being sent on visits to peoples homes that do not require assistance. Suppliers of telecare spend more money and time as they are required to supply the original poor telecare and then send people out to replace the poor telecare with good telecare. This also means that a second or duplicate assessment is required to be undertaken before the new telecare is provided, so extra resources there.

Good telecare provision should enable a person to undertake activities and have an enhanced quality of life. It should delay a person from accessing more drastic and severe services and allow them to choose to stay at home if that is what they want. Telecare following an enablement model saves all around. Short cuts can be containing and expensive. So which is the best method of providing telecare?

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