Tuesday, 16 December 2008

Telecare User Reviews

Telecare User Reviews

Telecare is a type of equipment that is unlike standard equipment provided by an Occupational Therapist (OT). It is unique. A bath board or bath lift might not function correctly but at least it is clear whether or not it works.

Most equipment, especially manual handling equipment has a standard by which it is reviewed. The review is as much as anything to ensure the working of the device as well as its suitability to meet the needs of the person.

So what about telecare?

In the UK there are no official standards for reviewing the telecare service or provision of equipment apart from the standard CSCI (Commission for Social Care Inspectorate) guidelines that apply to equipment. These mean that equipment should get an annual review.

Annual!

Yearly!

Every 365 or 366 days!


Surely something is not right here. As telecare is similar to many other forms of assistive technology we need to look for guidance in this arena. Sadly here we fail to find anything to assist us.

Telecare is new. By this I do not mean telecare devices are new, on the contrary most have their roots in devices decades in age. Rather the use of telecare to support people in their homes is new. This means that if you are to introduce something new, perhaps it is a good idea to review the current services that it will effect and draw up new ways of working to reflect this dramatic change.

Good practice suggests that a review of telecare should be taken initially within the first three months. This gives the user enough time to use the telecare and to determined if it works as expected as well as in the way they wanted it to.

Moreover, when we consider what telecare is designed to do, namely assist older, disabled or impaired people to maintain a quality of life and independence in their own homes, we can see that it is the most vulnerable of people that it is being used with. As telecare is used with vulnerable people it is likely that their needs will change, possibly quite considerably, within a year, sometimes within the month.

Consequently, if a person is initially reviewed after say three months then further reviews need to be scheduled, but these should not be annually. My own suggestion is that telecare should be reviewed every six months after the initial three month review.


Towards Good Practice?

What is even better practice, is to be person-centred putting the person first. If a client is vulnerable or disabled and there is a likelihood that their needs will be likely to change within three months, then the review schedule should be flexible to accommodate a two monthly or even monthly review. Of course 'Fair access to Care services' will have come into play here.

Furthermore, we need to consider what a review entails. Clearly, just asking a person whether they have telecare and whether it is still working are important, assuming the person has the capacity to understand what telecare is, but we need more information. We need to know that the person is actually wearing the fall detector and it is not just sitting on the bedside table. We need to know if any of their needs have changed or if they are likely to change (do they have an operation looming, which will make them more or less dependent on the technology).

We need to know their views on the technology whether it’s working for them and why they think so. We also need to go beyond the polite rhetoric of normal parlance into a qualitative world when the user can trust us to really say what the issues are. This is not easy and is ideally done in the field rather than remotely over a telephone.

So this brings us to 'capacity', the buzzword which is a useful one to know. Clearly if a review is to take place over and above the standard annual one, and is potentially going to involve a visit to someone's house then the company undertaking the review must have the capacity in terms of physical bodies and hours to undertake this venture. There is also a financial implication which puts the company into a position of spending considerable money on these reviews... to what end and return?

The best return is a proactive one, By ensuring telecare meets a person's need, we can enable them to remain independent for longer. It might mitigate hospital admissions. But there is never going to be any proof that telecare has made a direct saving, only conjecture. We can hypothesize that had we not put telecare in it is likely that the person would have ended up in residential care or hospital before a predetermined time but, as we all know, this is clearly just a guesstimate and a very crude one at that. People might end up in hospital even with telecare or without it, just as they might avoid it. We cannot predict humans’ behaviour and activities. When we try, we constantly fail.


Telecare User Review Guidelines


By reviewing someone we can also ensure that the person-fit to technology is still there. We can ensure that what is given to a person is still the best for them and they are happy to use it. The review might also trigger further reassessments if a person's needs have actually changed. This in the short term might cause a problem for service providers but in the long term, if we catch people before they become in need of extra services we win every time and we are ensuring our 'duty of care'. Moreover, it is also in the interest of the user.

I am still amazed that there are no guidelines on telecare reviews.

There should be.

More to the point, as we venture towards best practice in our work we need to be mindful of what we would want if we were on the receiving end of the service provision. Would you want a review annually? I am sure for some people annual reviews are fine, but I suspect for others every three months might not be ideal as they might require monthly ones.

We have to balance need with resources at all times. Evidently resources are the limiting factor here, but I suspect that if resources were made available for reviewing telecare in a person centred fashion in which we put people first then the rewards across the board will be enormous.

My major concern is that as we know, technology can enable and disable the user. The wrong telecare can certainly disable a person or potentially kill them.

If we are to undertake a review process then we need the resources. We need capacity and we need guidance.

I hope when the official guidance does come it is not at someone's expense.
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