Wondering about wandering
It is a while ago (2008) that I proposed the enablement/containment models as part of the Dependability Telecare Assessment tool (DTA) (http://www.smartthinking.ukideas.com/telecare.html and http://thetelecareblog.blogspot.com/2008/09/enablement-and-containment-models.html) in which I proposed that technology should enable people not contain them. So, 4 years on, I now turn my attention to those who have supposedly been enabled.
In the UK, there are a range of safeguarding structures in place to enable and ensure that a person has basic human rights and the ability to live an unfettered life. Locking the door on a demented family member was the option of a bygone age whereas today people are faced with the difficulty of ensuring the safety of a person who does not have capacity.
From a telecare perspective, there is a range of devices that are on the market that provide one or more of these four features:
1) to alert someone in the house of a person wandering
2) to alert a call centre when someone wanders
3) GPS based bespoke devices that can map where a wandering person is (as long as it is charged and with the person)
4) mobile phone based GPS/GSM systems that provide mapping and voice communication.
So, I am wondering, which is used today and which actually work effectively?
I recall, when I was working in a London Borough, that alerts to a family member in a house were the most effective, followed closely by the alerts to a call centre. But what is being used now and are they really effective?
I recall the problem with GPS tracking devices was that they required regular or daily charging and from what I can see this is still the case. Is their use limited to people who have family close by who are prepared to charge the devices? Additionally, you have to have the foresight to put it into a coat pocket or handbag so the person has it with them when they decide to wander. However, most people highlighted in assessment I did in London, were wandering at night partially clothed.
This means that through the safeguarding and enabling initiatives that have happened people who wander, be they older, younger or middle aged are left with few realistic alternatives. So how does this play out in the real world?
Enabling Who? - The real questions
Are friends and families put under more stress and strain to covertly contain their loved ones by locking them in and not telling anyone about it?
Are friends and families put under more stress and strain by providing their own 24-hour watch of the loved one?
Are families reliant on the telecare alert directly to them so they can drop everything and go looking for the missing person.
Has the responsibility for locating missing people been delegated to emergency organisations such as the ambulance or police services?
Has the responsibility fallen on social services to provide more care and assistance to the people who wander without friends or families?
I wonder, are the wanderers left to wander, and only after they have wandered several times with potentially dangerous consequences, are they then forced into a more contained environment where they cannot wander?
In the news, there is talk of tagging people with GPS type devices or ensuring that it is difficult for people to leave a property without actually stopping them. Both have drawbacks, the former being that this might not be consensual or hard to get agreement from families, and the latter might appear the best solution until the house is on fire and the occupant cannot get out.
I wonder is there another solution?
I wonder what is happening in the real world?
Is enablement the new containment?
Is telecare colluding in this containment in any way?
3 comments:
An interesting point is raised in this article, our Carephone Mobile covers the issues raised as comprehensively as we have been able to make it do so, a longer than average battery life helps with charging issues as well as an easy charge cradle, SOS neck pendant included helps around the home to raise awareness, and we have both a call centre that also uses GPS to track the handsets without the need for 'tagging'. As for your point about people remembering to take them this unfortunately is always going to be the case, as is charging any particular device, we hope that carers or family members will bridge the gap into helping users understand the operational requirements. I think that with a mobile handset being such an easily adopted technology these days the fact that a specialist 'senior mobile' like ours exists at least gives family members and carers an option to give wanderers the ability to gain assistance and vocal guidance at the push of a button. Anyway sorry to sound too self promoting of our product, I appreciate all innovation that helps solves problems and in our work hopefully we are getting there! Ben Lloyd. The Carephone
Response is still with family/friends/informal carers. Emergency Services - the clue is in the name - are there for emergencies and they see this as an avoidable occurrence not an emergency. We (e.g. Social Services) knew this was going to happen and did nothing to avoid it such as, as you say, contain the person - is the ES response.
We don't hold visual records; most of the people monitored have capacity and therefore cannot be forced back home because, after all, they are not wandering - they are purposefully walking. Meaning they know where they are going but unfortunately cannot communicate it to us so we don't know.
Ben's technology probably works great for those people that know they get a little confused at times but generally are OK. Where these technologies have been distributed en masse are from Local Authorities whose eligibility criteria is so high that the people that get these devices are passed the point of benefit.
In conclusion - great for kids; great for prvate paying occassionaly 'muddled' but not for the populus in this area. Independence at the cost of safety or containment at the cost of liberty - the choice is yours.
We are curtailed, at this time, by the scope of the technology, the way we apply it, our social care systems and our imaginations. This is compounded in many cases by our perception that “wandering “ may be aimless and meaningless. If we start from the stance that the individual with dementia is moving and walking around with a purpose, this will assist us to find the appropriate, individualised response to ensuring that the individual can move around in safety. The best person to inform us is of course the person with dementia. Whilst this may pose communication challenges we must invest time and effort, if we are to ensure we get the right response to need. Sadly both time and effort is not always made available.
Locally we are using a range of telecare and non-telecare based responses. Yes the technology does have limitations, often due to reliance on the human factor to charge the equipment, remember to place the equipment in an appropriate place to provide alert, be available to respond etc. We do provide a responder service, although this too may be limited in flexibility as we have to prioritise alerts and cover a fairly large geographical area.
I would dispute that enablement is the new containment, if there is a robust enablement process in place, which is truly personalised. This is what we would aspire to, although as with other aspects of social care we are constrained by the human factor, across all stakeholder groups. Equally the telecare in itself does not collude with containment, it is the way it is applied by the professionals and carers within the service users care plan, usually on the premise of risk management/risk aversion.
When we started the journey into using technology to support social care we did embark on a major process of re-education and cultural shift. Whilst we did start this journey over a decade ago we still have a long way to go. However as the optimist I do believe we are making headway albeit slowly.
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