Telecare promises independence for vulnerable adults and lower costs for councils, so why is it still so scarce?
Can I have my ‘tech’ please? Imagine that technology was distributed based on an assessment of need, rather than marketed directly for sale through retailers. Even when the need is acute, the distributor may withhold the gadget and instead provide an ‘equivalent’ service in person. So rather than give you a Kindle, they will send someone to your home to read books to you.
Sounds absurd? Consider then, the situation with telecare. This low cost equipment can be installed in the home of someone who is prone to falls, or whose dementia means they leave the cooker on or the bath running. Wireless monitors are triggered when an untoward event occurs, alerting a 24-hour monitoring centre. The centre communicates instantly with the individual through a loudspeaker in the home. If there is no satisfactory response, they contact a neighbour, relative or care worker to have them check that all is well. If needed, the emergency services can be called.
This gives users confidence and security and enables carers to take a break from constant vigilance.
So how do individuals get hold of telecare equipment? It is not generally marketed directly for sale through retailers but instead, users have to apply to their local council, who distribute the equipment based on an assessment of need. If they qualify for support, the council will design a package of care. Despite the fact that councils are under severe budgetary pressure, most will insist on providing a more costly package of traditional hands-on care.
Telecare is not a panacea and in most cases it will form part of a wider solution. However, the point remains; it promotes independence and costs less than many other forms of social care intervention, yet many councils do not deploy it extensively. This reflects two commonly voiced objections.
The first is that telecare equipment cannot replace hands-on care and the second is that there is no business case for it because telecare does not really reduce total costs of care. Clearly, until we invent robots that can feed an elderly person, then telecare will not replace human care; no-one is claiming it can.
Where telecare can be beneficial is in helping people to remain in their own homes with dignity and independence. It ensures that care is available exactly when required, rather than being provided around the clock, sometimes getting in the way of individuals’ lives. Equally, there is evidence from some councils that telecare can reduce the level of home care that individuals require and increase independence and self-sufficiency. A reduction of two hours of home care per week for an individual can save £1,600 a year – about double the average annual cost of a telecare service.
So savings and improvements in care need not be mutually exclusive. Supporting people in their own homes also lessens demand for residential care placements, which can cost upwards of £20,000 per year, reducing the personal distress of the need to sell the family home to pay for care.
There is evidence that telecare can help to delay admission to residential care by up to a year, delivering a win-win-win for individuals, their families and local councils. Early adopters of telecare such as councils in Bristol, Gloucestershire and North Yorkshire have deployed telecare services extensively. They are driven by a desire to maintain customers’ independence and a policy of not sending care workers into homes more frequently than is necessary.
Essex CC has taken the approach further, by providing telecare to people who do not yet qualify for any statutory service. The aim here is to manage the early effects of physical or mental decline and so delay the need for more expensive care.
The budget problems facing adult social care departments are leading many to re-evaluate the potential of telecare, but to secure the benefits they need to take five important steps.
Firstly, they need to prove the savings can be delivered locally as Wiltshire Council has recently done in an exercise that shows for every £1 spent on telecare, £3 could be saved.
Secondly, assessment processes must include a presumption that telecare will be deployed unless there is clear reason why it should not – reversing the current thinking.
Thirdly, this should be underpinned by agreeing a specific goal of maintaining independence during the assessment process.
The fourth step is that care professionals should share stories with customers where telecare has increased independence and satisfaction. There are many examples in councils that can be used for this purpose.
Finally, councils need to collect evidence that telecare is achieving the desired outcomes.
If these measures are put in place, then the true promise of telecare can be delivered for councils, carers and the vulnerable people they support.
Steve Carefull, telecare expert, PA Consulting Group
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