NATIONAL POLICIES AND LOCAL RESPONSES: PROSPECTS FOR THE USE OF ASSISTIVE TECHNOLOGY AND TELECARE FOR PEOPLE WITH DEMENTIA'?

Bridging the Gap Conference, London, 20th January 2010John Woolham

1

WHAT THIS PRESENTATION WILL COVER

1. A brief history of telecare & policy guidance2. Responses to the Preventive Technology

Grant3. Implications for people with dementia

2

1. HISTORY & POLICY GUIDANCE FOR TELECARE SINCE 1998: KEY POINTS

The first attempts to use assistive technology in care settings were for people with dementia

The Government has seen a key role for assistive technology for almost a decade

Driving the implementation of telecare has been difficult because of formidable barriers and a lack of an infrastructure at a local level to support the widespread use of assistive technology and telecare

Much work has been done by ICES (and now CSIP) to promote the wider use of assistive technology and telecare

After a false start, the Government willed the means as well as visioning the future for telecare with the PTG and PIs.

All of this progress raises new questions how have local authorities responded to the PTG? What might the implications of all this be for people with

dementia?

3

2. RESPONSES TO THE PTG – FINDINGS FROM A NATIONAL SURVEY 2006.

Carried out as part of an EPSRC research programme

Based on ICES/Telecare stakeholder collaborative databases –opportunistic not purposive.

Response rate to first survey was 43%

Response rate to second survey was 47% (but from self selected base of only 77 representatives)

Confidence interval for first survey was just under +/- 5%

679

232

13177

28 17

0

200

400

600

800

Sample size Respondents Exclusions

nos. 1st survey

2nd survey

4

2. RESPONSES TO THE PTG FINDINGS: OBJECTIVES OF LOCAL STRATEGIES

6 objectives predominated in Local Authorities with telecare strategies:support vulnerable people to remain independent by managing risks to independenceDelay or prevent permanent admission into residential carePrevent avoidable, unplanned hospital admissionPrevent unnecessary delays in discharging people from hospitalSupport carers and reduce carer stressContribute to local falls strategies and accident prevention

5

2. RESPONSES TO THE PTG FINDINGS: EXTENT OF AWARENESS OF PEOPLE WITH DEMENTIA IN PLANS AND STRATEGIES

80% said they wanted to prioritise the use of technology

The main priority groups – in order: Older people People living with dementia People susceptible to falling People with learning difficulties People with long term conditions and chronic illnesses Intermediate care users Younger adults with physical disabilities

Reasons for priority: To help people maintain their independence To provide a local response to government priorities or

targets To try to save money

6

2. RESPONSES TO THE PTG FINDINGS: FACTORS IMPEDING USE OF TECHNOLOGY

Funding Concern PTG would be spent elsewhere and not on telecare Concern about what happens when funding expires Concerns about the costs of technology

Achieving cultural change Lack of support by senior management Lack of support from front line staff Lack of enthusiasm by a key partner (e.g. Housing Dept,

PCT) Complexities of partnership working Mad re-organisation disease Lack of awareness & knowledge about telecare

Operational and service development issues Difficulties securing referrals for telecare Difficulties assessing for telecare Concerns about the reliability of telecare Difficulties in providing a social response

7

2. RESPONSES TO THE PTG FINDINGS: THE 2ND SURVEY: ASSESSMENT & PROVISION, CONSENT, PROCURING & USING TELECARE

Assessing and providing Some intended to provide technology just to high need/risk

groups, others to people who fell outside eligibility criteria 1/3 said they intended to provide at least some AT/telecare

without a full assessment – but where this was so there would be restrictions on the kinds of technology available

Consent Over half said they’d use technology even if the person could

not consent to its use Amongst this group, over 2/3 said they’d seek consent from NoK,

almost half said they’d use an ethical protocol and over 40% said it would be subject to close monitoring

Procuring and using 1/2 said they’d procure from several manufacturers: 1/3 said

they’d use a single supplier Over half intended to use local call centre staff to install

technology Almost 1/3 intended to use the manufacturer or supplier as

installers The great majority felt that alarms would be handled by local call

centres: relatives were seen as the main group who would provide the ‘social response’

8

THE NATIONAL DEMENTIA STRATEGY & TELECARE

‘Objective 10: ….the needs of people with dementia and their carers should be included in the development of…. assistive technology and telecare. As evidence emerges, commissioners should consider the provision of options to prolong independent living and delay reliance on more intensive services’. (p.55).

Lack of evidence seen as a barrier to more widespread take up

‘There is a more substantial evidence base to show the opportunities offered by assistive technology and telecare to enable people with dementia to remain independent for longer, and in particular to help the management of risk. But the data on newer approaches are still sparse and inconclusive. An evaluation of one scheme demonstrated cost effectiveness and reports of improved quality of life. Large-scale DH field trials of such technology are currently under way.’ (p.56).

9

3. IMPLICATIONS FOR PEOPLE WITH DEMENTIAHOW FAR HAVE WE COME IN SEVEN YEARS?

ASTRID 1998 market analysis Lack of knowledge and information

about what technology could do

Limitations to the design of technology

Limited numbers of manufacturers and suppliers

An absence of staff with skills to install and commission technology

Access to AT by people with dementia non existent

Now More information: e.g. ICES/CSIP

work on telecare, Atdementia.org.uk Still a widespread lack of knowledge Technology is more ‘dementia

friendly’ but ‘design for all’ still a long way off.

A few new companies around but still dominated by a handful of manufacturers

Still no ‘trusted assessor’ approach to ensure people who assess, have sufficient skills and the right skills.

Access to AT now possible on the open market – but is this always a good thing?

10

3. IMPLICATIONSKEY ISSUES FOR DEMENTIA CARE

1. Mainstreaming has moved the focus away from dementia

2. What does prevention mean? 3. Prevention vs eligibility criteria4. Long term funding5. Limited opportunities for extending the role of

assistive technology and telecare6. Assistive technology as a substitute for social care7. Overlooking benefits of AT in hospital or residential

care settings8. Local priorities9. Knowledge and skill deficits10. Unintended consequences of performance indicators11. Person centred use or technology driven services

11

REFERENCES

1. Marshall, M., (ed.) (2000) A Social and Technological Response to meeting the needs of People with Dementia and their Carers Hawker Publications, London.

2. Woolham, J., Gibson, G., & Clarke, P.,(2007) Local responses to the Preventive Technology Grant: findings from a two-stage survey of local stakeholders)

3. http://www.atdementia.org.uk/content_files/files/SurveyoflocalresponsestothePTG.pdf

4. Woolham, J., Gibson, G., & Clarke, P., (2006) Assistive Technology, Telecare and Dementia: some implications of current policies and guidance (Research Policy & Planning Vol. 24 No. 3.)

5. Living well with dementia: A National Dementia Strategy (Feb. 2009) Department of Health, London.

12