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?
A person-centered Telecare blog featuring the Dependability Telecare Assessment tool (DTA).
Showing posts with label Models of telecare. Show all posts
Showing posts with label Models of telecare. Show all posts
Thursday, 15 December 2011
Tuesday, 13 July 2010
The increase in telecare
With the release of the UK government’s “Equity and excellence: Liberating the NHS” document the emphasis for health promotion falls on GPs as they will be getting the vast amount of money from the dissolution of the PCTs (Primary Care Trusts). This really interests me. When I worked for social services in North London, I found that GPs were by and large a very difficult group of people to interest in telecare. Actually finding access to their forum was hard and harder still to get any enthusiasm for the potentials of this new technology.
It seems that with the release of this document and the fact that the commissioning of services will be undertaken predominantly by GPs in the future that they are going to need a crash course in telecare, telehealth, mHealth and eHealth.
So how is this going to happen?
Who is going to do this?
The only way that this can be done is for telecare to be included in the documentation that the government produce but it is nowhere to be seen.
If we are to follow the preventative agenda, then surely telecare must be the spearhead of changing the way we consider health and care. Ideally as a result of the proposed changes and the distinct lack of money in the UK it behoves all GPs to get tele-trained pretty quickly.
I can see that this should also not be something that comes from the manufacturers as this could bread suspicion in GPs rather I can see a role in this for the TSA (Telecare Services Association) as well as the government to bring this information to the desktops of the General Practitioner of tomorrow. But before this can happen, how are can the profile of telecare be raised to such an extent that GPs will actually begin to take a message on board that they have resisted for the last five years?
Any answers gratefully received!
It seems that with the release of this document and the fact that the commissioning of services will be undertaken predominantly by GPs in the future that they are going to need a crash course in telecare, telehealth, mHealth and eHealth.
So how is this going to happen?
Who is going to do this?
The only way that this can be done is for telecare to be included in the documentation that the government produce but it is nowhere to be seen.
If we are to follow the preventative agenda, then surely telecare must be the spearhead of changing the way we consider health and care. Ideally as a result of the proposed changes and the distinct lack of money in the UK it behoves all GPs to get tele-trained pretty quickly.
I can see that this should also not be something that comes from the manufacturers as this could bread suspicion in GPs rather I can see a role in this for the TSA (Telecare Services Association) as well as the government to bring this information to the desktops of the General Practitioner of tomorrow. But before this can happen, how are can the profile of telecare be raised to such an extent that GPs will actually begin to take a message on board that they have resisted for the last five years?
Any answers gratefully received!
Thursday, 18 June 2009
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.
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?
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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