"When I use a word," Humpty Dumpty said in a rather a scornful tone, “it means just what I choose it to mean --- neither more nor less."
"The question is," said Alice,"whether you can make words mean so many different things."
"The question is," said Humpty Dumpty, "which is to be master--- that's all."
Lewis Carroll – Through the Looking Glass.
I am not sure about you, but I think it is time to resurrect the debate about terminology. I have recently been to a number of conferences and at these events people use the words Telecare, Telehealth, Telemedicine and Assistive Technology interchangeably. The speakers seem to appear confused because they are using the words Telemedicine when they are talking about Telehealth and Assistive Technology to mean anything and everything. The term assistive technology (AT) seems to have become an umbrella term for Telecare, Telehealth and Telemedicine which is a little strange as AT is so much more than these small bits. It denigrates the words Assistive Technology. AT after all comprises of environmental control systems, speech helpers any form of technology that can enable an impaired person (http://en.wikipedia.org/wiki/Assistive_technology).
I am not sure that Telehealth enables people in the same way that Telecare does or even qualifies to fit under the banner of Assistive Technology. If you look to the right hand bar I have the definitions of Telecare and AT as: Telecare is the continuous, automatic and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living (http://www.telecareaware.com/index.php/what-is-telecare.html).
I would argue that Telehealth monitors patients' health and alerts professionals of possible emergency situations but in a very different mode from Telecare. Telecare produces alarms; it sends real time alerts through to a call centre 24 hours a day; 7 days a week. Telehealth produces less frequent monitoring intervals and the information is sent to staff who are only working when they are at work (often 37½ hours a week). I would also argue that Telehealth does not manage risks associated with independent living, rather it manages peoples' health conditions and possible health deterioration. Therefore, Telecare and Telehealth are significantly different.
On the other hand Assistive Technology (AT) is any product or service designed to enable independence for disabled and older people. (King's Fund, 2001). So Telecare is a small subset of assistive technology. It is not the whole spectrum of assistive technology. Hence, when referring to Telecare, one should use the words Telecare not assistive technology. "the smoke detector is a vital part of assistive technology" is more accurate as "the smoke detector is a vital part of the Telecare repertoire". "Johnathan was helped through the use of assistive technology, the use of augmentative and alternative communication software enables him to communicate for the first time in class". If, for example, I worked with Assistive Technology, I would expect to have some medically training, to have a qualification in engineering and have undertaken the training associated with all people who work in this field. These are very highly skilled people who have years of experience and expertise to offer.
Keren Down from FAST (www.fastuk.org) puts the explanation beautifully “The confusion seems to arise due to the fact that assistive technology is not a term fitted for day-to-day use and that it has been used in very specific (service defined) contexts. It is a term well fitted for strategic planning. An analogy is the term ‘transport’. On the whole people don’t say ‘I’m going to go and take a transport up to the Elephant and Castle’” (http://www.telecareaware.com/index.php/telecare-telehealth-terminology.html).
I would also argue that Telehealth does not fit with the AT definition. Telehealth does not per se actually “enable independence for disabled and older people”. Telehealth supports older and disabled people’s health conditions. I would agree that by these conditions being stabilised the person might be more likely to be independent but this is a by-product of Telehealth not a given. There will be many very sick people who will have their conditions monitored by Telehealth devices in the future but who will not be enabled to be independent as they are too ill.
To me, Telehealth is like a heart monitor people wear at the gym, it is there to monitor fitness where as AT is the machines that people use to get fit. No matter how much you wear a heart monitor it will not make you fit but using the exercise machine will. The gym on the other hand could be considered to be assistive Technology comprising of lots of different component parts.
I think that it is really important that we all understand the basics, and all speak in the same language. If we assume people understand the terms we use then we are making an Ass out of U and Me!
You may not feel that terminology is something we should get het up about, we all 'sort of' know what the person is meaning, but I would argue it is critical! If I am talking to someone about Telecare and they think I am talking about patients in hospitals not people at home, then we start from completely different places. Anything we say after that is interpreted in terms of the initial impression. When I go abroad or talk to people from other countries it often takes a long time to ensure we are both talking about the same thing and understand the words in the same way. If we fail to do this then a conversation can be futile or even dangerous depending on what the other party takes away with them.
So instead of being Humpty Dumpty who states “When I use a word…it means just what I choose it to mean --- neither more nor less” let us use a word to mean what it means, nothing more, nothing less. Moreover, let us ensure that we put pressure on the powers that be to reach clear definitions of the words we need to use… Assistive Technology, Smart Home, Telecare, Telehealth, Telemedicine, e-Health, e-Medicine, mHealth etc. If we don’t decide what they mean soon it will be too late. It is time we master our language within this field.
Friday, 29 January 2010
Thursday, 19 November 2009
The TSA Conference 2009 report of exhibitors
The Telecare Services Association Conference 2009, Hilton London Metropole Hotel - Report of Exhibitors
Although there were loads of excellent people presenting their wares at the Conference certain ones were found by the author to warrant considerable attention.
The NEAT dispersed alarm supplied by Possum
First up is the NEAT dispersed alarm that Possum had on their stall. Apart from the size and design quality/looks there are a number of excellent features that make this something to watch. Firstly the dispersed alarm unit is small and thin with three buttons which are clear. The unit has a voice unit which can pick up on someone calling for help and trigger an alert to the call centre (the round item in the middle of the picture with the red button on it). The other thing that I really like is the fact that the unit and each device provide a handshake. The handshake means that each device can communicate with the other devices in a smarter fashion as information can go bi-directionally. This opens many possibilities. The main possibility demonstrated to me was the fact that if a device fails by using a simple pendant you can easily find the failing device as the handshake will not occur, as demonstrated by a light on a pendant.
Another thing that I really liked was the fact that each device works in its own state. In this way the system can be a standalone system that can send an alert to the pager in the bottom right of the picture alerting the carer that the person is in difficulties. Any device can be set to do this without the need for the dispersed alarm. Furthermore the pager can be set to have a range of functions such as pass the alert to another pager or accept the alert. The most obvious benefit I can see for this is in supported living services where care staff might require extra help or the person themselves can start to use technology to enable a more independent lifestyle.
The other most important thing the NEAT system can do is to act as a wayfinding device to assist the user in maintaining independence. This can split the house into various zones and these zones can be defined by the practitioner or family or person. If you go out of zone then it is up to the practitioners or family to determine the best course of action. This is just the beginning of what this system can do so keep your eyes open for news on the NEAT system.
The Halliday James Stand
The Halliday James Ltd stall where Bernard Wignall demonstrated the excellent range of technologies that they have developed to support wayfinding. These include mobile phones, simple pendants with GPS and GSM capabilities as well as handheld units that have maps and so forth on them. What impressed me with this is the way in which the person using the technology was always at the forefront of all the design ideas and decisions. The two best products demonstrated were the HTC smartphone in the top of the table that can provide a decision support system for people with memory problems. This is very similar to the things I saw in the
The other standout item from Halliday James Ltd was the standard looking watch below the mapping device in the picture. This is a normal watch and could be the person’s own watch but the strap has a GPS/GSM unit built into the base – out of sight. Therefore the unit looks like normal watch but is actually as wayfinding device. Simple good design shining through again.
The third company stall that had something standout to show was Chubb Community Care who finally produced two things I have been looking forward to, and they have been promising, for some time. The first is the new fall detector which as the picture shows is a wrist worn device. It looks like many other wrist worn devices and has a black emergency call button on it. In actual fact it looks just like a standard pendant on a wrist strap but actually is a fall detector that will detect ‘out of ordinary bumps’. “When a fall alarm is raised, the technology will vibrate immediately, during this period if the user does not want to send out the signal of the alarm, they just have to move their arm which will cancel the alarm. If this is not done then a call will be sent through the IntelliLink carephone or to the Carer Alert so the appropriate response can be sent”. Its not rocket science to see that this is fraught with potential possibilities for falls to be canceled as the person is crawling along the floor or some such activity that mimics the cancellation mode. But to their credit it is a well designed and well thought out piece of kit. If the person does decide to wave their arms in the air after a true fall and cancel the signal it can still be reactivated by pressing the black button. So a fail-safe is in place. I am looking forward to testing these out.
The Chubb Flexible Bed Occupancy sensor
Another thing by Chubb that I have been waiting for is the blue flexible mat that acts as a bed occupancy sensor (BOS). This is currently not to be found by me on their website. This is the mat shown above the standard BOS mat. The reason for this mat being exciting is that it can be used on pressure relieving mattresses which inflate and deflate. I am also pleased to see it connected to the new Chubb Bed Occupancy Monitor which enables personalised timing features so that these devices can finally be timed to meet the needs of the person.
This proves to be a valuable conference for many reasons. Not only is it the place to meet and touch base with the Telecare Gurus, but it is also the place to find out what the future direction for Telecare is to be. But for me, the best thing is to see how some manufacturers are still churning out the same things whilst others are beginning to see the true potential of listening to the people who use their devices.
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.
Wednesday, 10 June 2009
Some web publicity
I have recently featured in two ventures I am pleased to be part of one working with the UK consumer affairs magazine Which? and the other an interview with Hometoys Emagazine which is the smart home site. Versions of these are available on line:
The Which? article can be found at http://tinyurl.com/nqmhbv
The Hometoys piece can be found at http://tinyurl.com/l5aqs8 - Amended link sorry for the previous error.
The Which? article can be found at http://tinyurl.com/nqmhbv
The Hometoys piece can be found at http://tinyurl.com/l5aqs8 - Amended link sorry for the previous error.
Friday, 27 February 2009
Defining Telecare
Tele (at a distance) Care.
Any attempt to define Telecare is fraught with contradictions. Here I try to demonstrate the wealth and diversity of the various definitions of Telecare. Let's start with a definition on TelecareAware which comes from an unknown source but is a good lead in:
“Telecare is the continuous, automatic and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living.”
Steve Hards (http://www.telecareaware.com/index.php/what-is-telecare.html (accessed Dec 2008).
Defining Telecare is not simple. The definition above contrasts with the following definition by NHS Purchasing and Supply (PASA):
"Telecare describes any service that brings health and social care directly to a user, generally in their homes, supported by information and communication technology. It covers social alarms, lifestyle monitoring and telehealth (remote monitoring of vital signs for diagnosis, assessment and prevention).
“Telecare covers a wide range of equipment (detectors, monitors, alarms, pendants etc) and services (monitoring, call centres and response).
“Telecare equipment is provided to support an individual in their home and tailored to meet their needs. Telecare services range from a basic community alarm service that is able to respond to an emergency and provide regular contact by telephone to an integrated system that includes detectors or monitors (i.e. motion, falls, fire and gas) that trigger a warning to a response centre. More complex systems include telemedicine, which is designed to complement healthcare via monitoring vital signs such as blood pressure. Data is transmitted to a response centre or clinician’s computer where it is monitored against parameters set by the individual’s clinician."
http://www.pasa.nhs.uk/PASAWeb/Productsandservices/Telecare/LandingPage.htm (accessed Dec 2008)
Telecare utilises information and communication technologies to transfer medical information for the diagnosis and therapy of patients in their place of domicile.
(Norris A C, 2002, 4)
A distinct problem with Telecare is its lack of a clear definition. Moreover, the definition of Telecare is constantly modifying depending on who is writing or what the current “in word” is. The first definition above situates Telecare within the social framework whereas the second situates it clearly as medically allied, whilst the third definition sees Telecare as solely a medical intervention transferring medical information. To add to the discussion the Department of Health’s Care Service Improvement Partnership (CSIP) emphasises the remote monitoring aspects of it as well as its use in reducing admissions in their definition:
"Telecare is a broad term which encompasses a wide range of technologies with remote monitoring that can support people to remain independent and potentially reduce the frequency of hospital and care home admissions as well as give peace of mind and reassurance to users, carers and their families."
http://networks.csip.org.uk/IndependentLivingChoices/Telecare/AboutTelecare/ (accessed Dec 2008)
Whereas for David Bradley et al (2002) Telecare is a purely medical allied intervention, when the define Telecare as:
“An holistic approach to the remote provision of healthcare, assistance and monitoring in a community setting, via the use of appropriate technologies, in order to assure client well being.” (Bradley, Williams, Brownsell and Levy (2002) 'Community alarms to telecare – The need for
a systems strategy for integrated telehealth provision' Technology and Disability 14, 64.)
This can be contrasted with Kevin Doughty's recent definition of Telecare as an umbrella term for Domestic AT systems.
"Telecare has become the umbrella term for all assistive and medical technologies that depend on modular, relatively inexpensive and quickly deployed, electronic devices and/or telecommunication systems that help people to maximise their independence within the home environment." (Doughty K, 2007, “Telecare Practice and Potential”).
What is clear is Telecare means different things to different people. Moreover the term Telecare is a euphemism for whatever the new policy of the day is.
The author describes Telecare as the ability to harness simple technology to enable and empower people such that they can live independently in the community. Telehealth and Telemedicine are technological applications which centre on the health aspects of the person and supporting them in the home or hospital. This though is very close to the first definition offered by Steve Hards.
Without a clear strong fixed and universally accepted definition of Telecare, how can Telecare services develop plans and ensure that the people who require Telecare receive the correct information and services?
Any attempt to define Telecare is fraught with contradictions. Here I try to demonstrate the wealth and diversity of the various definitions of Telecare. Let's start with a definition on TelecareAware which comes from an unknown source but is a good lead in:
“Telecare is the continuous, automatic and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living.”
Steve Hards (http://www.telecareaware.com/index.php/what-is-telecare.html (accessed Dec 2008).
Defining Telecare is not simple. The definition above contrasts with the following definition by NHS Purchasing and Supply (PASA):
"Telecare describes any service that brings health and social care directly to a user, generally in their homes, supported by information and communication technology. It covers social alarms, lifestyle monitoring and telehealth (remote monitoring of vital signs for diagnosis, assessment and prevention).
“Telecare covers a wide range of equipment (detectors, monitors, alarms, pendants etc) and services (monitoring, call centres and response).
“Telecare equipment is provided to support an individual in their home and tailored to meet their needs. Telecare services range from a basic community alarm service that is able to respond to an emergency and provide regular contact by telephone to an integrated system that includes detectors or monitors (i.e. motion, falls, fire and gas) that trigger a warning to a response centre. More complex systems include telemedicine, which is designed to complement healthcare via monitoring vital signs such as blood pressure. Data is transmitted to a response centre or clinician’s computer where it is monitored against parameters set by the individual’s clinician."
http://www.pasa.nhs.uk/PASAWeb/Productsandservices/Telecare/LandingPage.htm (accessed Dec 2008)
Telecare utilises information and communication technologies to transfer medical information for the diagnosis and therapy of patients in their place of domicile.
(Norris A C, 2002, 4)
A distinct problem with Telecare is its lack of a clear definition. Moreover, the definition of Telecare is constantly modifying depending on who is writing or what the current “in word” is. The first definition above situates Telecare within the social framework whereas the second situates it clearly as medically allied, whilst the third definition sees Telecare as solely a medical intervention transferring medical information. To add to the discussion the Department of Health’s Care Service Improvement Partnership (CSIP) emphasises the remote monitoring aspects of it as well as its use in reducing admissions in their definition:
"Telecare is a broad term which encompasses a wide range of technologies with remote monitoring that can support people to remain independent and potentially reduce the frequency of hospital and care home admissions as well as give peace of mind and reassurance to users, carers and their families."
http://networks.csip.org.uk/IndependentLivingChoices/Telecare/AboutTelecare/ (accessed Dec 2008)
Whereas for David Bradley et al (2002) Telecare is a purely medical allied intervention, when the define Telecare as:
“An holistic approach to the remote provision of healthcare, assistance and monitoring in a community setting, via the use of appropriate technologies, in order to assure client well being.” (Bradley, Williams, Brownsell and Levy (2002) 'Community alarms to telecare – The need for
a systems strategy for integrated telehealth provision' Technology and Disability 14, 64.)
This can be contrasted with Kevin Doughty's recent definition of Telecare as an umbrella term for Domestic AT systems.
"Telecare has become the umbrella term for all assistive and medical technologies that depend on modular, relatively inexpensive and quickly deployed, electronic devices and/or telecommunication systems that help people to maximise their independence within the home environment." (Doughty K, 2007, “Telecare Practice and Potential”).
What is clear is Telecare means different things to different people. Moreover the term Telecare is a euphemism for whatever the new policy of the day is.
The author describes Telecare as the ability to harness simple technology to enable and empower people such that they can live independently in the community. Telehealth and Telemedicine are technological applications which centre on the health aspects of the person and supporting them in the home or hospital. This though is very close to the first definition offered by Steve Hards.
Without a clear strong fixed and universally accepted definition of Telecare, how can Telecare services develop plans and ensure that the people who require Telecare receive the correct information and services?
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.
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.
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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