Wednesday, 24 September 2008

Telecare a risky business

So lets look at the telecare assessment in more detail. There seems two strands of thought here, 1) of containment and 2) enablement. More explicitly, the notion of measuring and basing judgments upon risk or measuring and judging need. What is clear is that risk and need are not the same. Often they are put together as if they are mutually compatible, but in reality they are quite different.

Risk assessments are useful as they are about the causation of harm and the mitigation of this harm to an individual. Telecare is apt for this as flood, gas and fall sensors are all about ensuring the person does not experience harm or harm reduction. The problem of concentrating on harm reduction and risk analysis is that it is often at the expense of looking beyond the immediate risk. The person is falling.. lets give them a fall detector, rather than stepping back to inquire why are they falling, can we prevent or assist in minimising the falls? Risk analysis of telecare can be achieved in a number of ways such as self assessments or checklists (have you ever had a flood?) without the background detail many people will answer yes to this type of question, as they did have a flood but it was three years ago, or they had one last week as the flat upstairs flooded and the water came in to their place. If this approach is followed to its logical conclusion then it performs a simple containment mechanism where people are given telecare to mitigate risk without ever trying to address the real issues of why the risks are there. Analysing risks is not wrong, it is just not enough by a long chalk.

So what is the option? Person-centred planning of telecare which is truly needs based and holistic is the only possible solution. If the assessment addresses the needs of the whole person and their lifestyle and activities then if telecare is required it will mitigate risk whilst having the correct 'person-fit'. This is a double winner, the person is happy with the intervention and any intervention will last for longer and be more effective.

So mitigating risk is too tunnel visioned to be the main reason for interventions. The other issue with risk mitigation is that it tends to centre on technology to the expense of really seeing what and how the person being assessed ticks. It forces the assessor to concentrate on how technology can be used with the person instead of seeing how the needs of the person can be met, which means telecare is one possible option.

So needs based interventions are person-centred and enabling whereas risk based interventions are potentially disabling and containing.

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