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Technology to Care - Launch of workforce learning strategy, implementation plan & Knowledge and Skills Sets to embed electronic assistive technology (eAT) in social care “Support for an increasing use of AT & telecare to support independence & social inclusion” Kevin Doughty Independent Consultant, and Co-Director, Centre for Usable Home Technologies, Universities of York & Newcastle Media Resource Centre, Llandrindod Wells Wednesday, 12th. March, 2014 The Context of AT & Telecare Demography and expectations UK’s Ageing Population 30 Wales England Scotland N. Ireland 25 20 15 10 5 0 1985 2010 Year 2035 © KD 2014 The Context of AT & Telecare Demography and expectations The Cost of Care & Support The Cost of Care Maximise Quality of Life SHIFT RIGHT 2 years = £18K Sheltered Housing Care homes Nursing homes 3 days = £18K Intensive care unit Self care Home care Assisted Living Facilities Residential care homes Community General hospital ward 5 months = £18K Home Hospital £1,000 30 years = £18K £100 £10 £1 Cost per day © KD 2014 Budget Squeeze Chronic disease © KD 2014 The Context of AT & Telecare Demography and expectations The Cost of Care & Support ervice & technology improvement Potential Benefits of using Telecare Service Users Carers Social Services Housing Providers Health Economy Increased choice Improved peace of mind Reduce/delay admissions to care homes Reduced level of voids Fewer admissions & readmissions More responsive approach Reduced stress Improved needs & risks assessments Increased demand Improved medication compliance Improved Quality of Life Improved Quality of Life Fewer delayed care transfers Fewer accidents and incidents Fewer A&E presentations Increased independence Increased independence Increased capacity of care system New roles for support staff More able to self care at home Reduction in care costs Opportunities for respite Reduced demand for homecare Improved security of properties Shorter hospital stays © KD 2014 The Context of AT & Telecare Demography and expectations The Cost of Care & Support Workforce development & training ervice & technology improvement Opportunities for Service Growth • Extend the propositions to other user groups • Improve service delivery propositions • Consider the role of the carer • Improve the quality of the services processes • Focus on the enablement agenda • Integrate telecare with functions for integration • Adopt a whole of market approach • Exploit the potential of the retail market • Embrace “always-on” (ADSL) connections • Look at opportunities for video interaction Telecare Application Groups & Scenarios Social housing Frail Elderly People Physically disabled Visually impaired tenants Mental health patients Mobility issues End of Life care Victims of Domestic Abuse Supported housing Children & Families Insecure and anxious Recent hospital discharges Neurological conditions Speech deficits Enablement services Deaf or hearing impaired Extracare scheme Cognitively challenged Lonely or social isolated People with learning disabilities Long term conditions Targets for bogus callers Standar Telecar Approach Service User, Alarm type and location info Public Telephony Network Service User’s Home 2-way Speech channel Ouch! Telecare Response Monitoring 1. Sensor automatically raises alarm to dispersed unit Centre (TMC) 2. Alarm call raised 3. TMC Operator talks to Service User 4. TMC Operator follows protocol and arranges appropriate response © KD 2014 Two Levels of Telecare Proposition Supporting people Sheltered housing Self-care Self-pay L.A. Family Self-pay Sale of home L.A. NHS People living independently in the community with support from family and friends Anxiety pressures 25 years PREVENTIVE TELECARE & AT SERVICE £100 - People living (often) alone Risk pressure in their own homes with and/or carer £400 burden per weekdomiciliary or family care COMPLEX TELECARE & AT SERVICE £400 £1000 per week People in residential/ nursing care homes 2.5 years Median stay: Residential - 665 days Nursing - 418 days Likely cost = £46k © KD 2014 Risks to Independence that Telecare Can Help to Control or Manage Environmental Personal Social WellSafety/Security being safety Fire Floods High Temperatures Low Temperatures Noise Air quality Frozen pipes Radiation Explosive gases Electrical problems Magnetic field Personal Care Health Intruders Bogus callers Doors/ windows insecure Going out inappropriately Trips and falls Loneliness Isolation and Exclusion Lack of exercise Hygiene Depression Nutrition Boredom Forgetfulness Scalds Gas & Carbon Monoxide hazards Cooker or hob inappropriate use Risk of abuse Financial difficulties Narcotic gases Neighbourhood disagreements Fear of crime Risk of abuse Speech impediment Challenging behaviour Impaired vision Impaired hearing Reduced cold tolerance Reduced dexterity Reduced mobility Poor hydration Mood swings Incontinence Pressure sores Medication compliance Long term conditions Asthma attacks Cardiac arrhythmia Hypoglycaemia Sleep apnoea Stroke Epileptic seizures © KD 2014 But It’s Easy to See How it Can Work and Keep People and Their Homes Safe BEFORE and AFTER Risk Management Actions for Frail Elderly People Who Might Fall Action Effect Detect falls quickly through telecare Exercise programme (including Tai Chi) Training to get up from the ground Perform home survey Improve lighting Introduce automatic lighting Regular eye-checks Spoken reminders Treating conditions such as postural hypotension and cardiac arrhythmias Providing dietary supplements Managing medication Monitoring of activities with personalised information and advice Time using Powerplate vibration machine Reminding service user to maintain adequate levels of nutrition and hydration Increase confidence of individual; prevent a long lie Improve balance, strength and gait Reduce likelihood of a long lie Reduce the number of environmental hazards Compensate for loss of visual acuity Avoid trips in a darkened room at night Correct visual problems through lens prescription Reduce likely of not wearing glasses or slippers Avoiding problems with syncope and blackouts Reducing likelihood of bone fractures Reducing likelihood of falls Improvements in lifestyle so that the likelihood of a fall is reduced Improves balance and strength in legs Reduce the loss of body strength and chances of falling due to delirium Phases of a Fall Event •The pre-fall phase - the individual is going about their everyday activities which might involve periods of motion that include sudden movements e.g. during transfer •Critical phase - this is the sudden movement of the body toward the ground, ending with a vertical shock upon impact. The duration of this phase is extremely short ≈ 300 - 500 ms •Post-fall phase - the individual is likely to be inactive, perhaps lying on the ground as they come to terms with their situation; and •Recovery phase - the recovery phase is when the individual attempts to rectify the situation by getting up; either by themselves or with help from others. e-AR Sensor Tiny vestibular organ „ 3 semicircular canals or hollow tubes „ Each tube detects the 3 different motions: pitch (x), roll (y) and yaw (z) „ Each tube filled with liquid, and the tube contains millions of microscopic hairs „ z x y Accelerometer Bed Exit Sensors & Alerts • Falls at night can be the most serious because they can lead to “a long lie” • The alarm needs to be raised if someone leaves bed during the night but doesn’t return within a certain time • A light may be switched on automatically as they leave the bed, and switched off when they are back • Most sensors will only work with standard beds • Others will work with profiling (hospital) beds, and also with alternating pressure mattresses © KD 2013 Other Bed Exit Sensors & Alerts © KD 2014 Dementia - monitoring and tracking starts in the home Only 40% of people with dementia will ever go out and become lost Those who do exhibit this behaviour do so for a limited period Start with Low Tech And Then Higher Tech © KD 2014 Totally Standalone - Local Alert Service User’s Home ! What if the family carer has only one concern, and needs only one sensor (and means of raising an alarm) to let him or her know of a potential problem? 1. There may be a large choice of sensors- but sensor must still automatically raise alarm to local (lower cost) receiver/pager device 2. Local responder (within the home) is alerted to the problem 3. Local responder aids service user © KD 2014 Filter A Welsh Telecare Model Referral Activity monitoring to confirm risk levels Collection of information on deficits, support and capabilities Review & evaluation Community Support & Logistics w, Alerts & Reports Response Co-ordination Home Safety & Hazards Survey Non-Emergency Call or Visit Emergency Response Telecare equipment Ta ga personal telecare service Property Access Administration cords Call Handling Risk & Needs Assessment Assistive devices Response Protocols Escalation Procedures Client Consent & Commissioner approval Equipment Deployment Other support services Ancillary Works Maintenance, Recycling & Testing © KD 2014 Life and Life-changing Events Accident, Illness or Bereavement Limit of ability to self-care Shot dead by jealous husband - at 90! Accept Proactive Support for independence Accept Dependency Death Time © KD 2014 KD’s 10 “P”s of Prevention and Enablement • Personal care - e.g. assisting with washing, dressing • Practical support - e.g. assisting with meals & laundry • Priming people with information & signposting • Psychological & emotional help - e.g. taking for a walk • Proving their safety - e.g. attending social engagements • Performing adaptations - making the home safer • Providing equipment - simplifying domestic tasks • Pushing best practice to reduce the risk of falls • Prompting medication and nutrition • Promoting confidence - 24/7 digital healthcare support © KD 2014 Telecare & the Prevention Agenda Primary Care nursing Minor home adaptations Family and friends Aids to Daily Living Allied health therapies INTEGRATED TELECARE SERVICE Homecare services COMMUNITY CARE Smart home systems Connected healthcare TECHNOLOGY 29 © KD 2014 Integrated Telecare Approach Minor home adaptations CARE AND REPAIR CYMRU Aids to Daily Living COMMUNITY EQUIPMENT STORE Smart home systems TELECARE SERVICE Home-based telecare 30 © KD 2014 Telecare EPG - Online Knowledge-based Toolkit for Telecare Professionals Learning Resources + Prescription Guidance Manuals + Product Reviews & Benchmarking + Decision Support Tools Independent & Impartial and fully searchable Product Guidance & Advice Supported by our partners for crowd-sourced opinion via CUHTec 600+ items of telecare & related equipment Whole of market No charge to suppliers to encourage inclusion Product of the Month Opinion articles Tutorials + Prescription Guidance + Product Database www.t-cubed.co.uk © KD 2014 Able-World Stores • Large retail outlets allow customers to browse products and to try devices before committing to a private purchase. • Telecare products are included and can be installed bv a partner organisation © KD 2014 On-line Retail Operations AbleWorld also sell online without assessment, but only one telecare brand © KD 2014 2nd Generation Telecare - Continuous Assessment Using Fixed Telephone Lines KD 2014 Activity Monitoring - Trend Analysis © KD 2014 Average Download Speeds for Fixed Broadband Connections in Urban, Suburban and Rural Areas © KD 2014 Wales - Haves and Have Nots (in terms of broadband access) 3rd Generation Telecare - Focus on the Television • Reaching older and vulnerable people is difficult when they are resistant to, or not comfortable with,: Computers Mobile phones Tablets/second screens? • Which, if any, communication technology are they comfortable with? © KD 2014 Care Messenger • Care Messenger is a unique interactive communication tool that allows personalised messages to be targeted to individual TVs overlaying commercial TV channels. • Pill reminders, activity announcements from housing managers, visit prompts from nurses, carers, and plumbers, ‘good morning’ monitoring, and comforting SMS messages from family and friends, can all be delivered © KD 2014 • Simple, low cost arrangement that I am trialling for enabling video consultations in the homes of older people • Ideally suited to people who want Skype services but without a computer © KD 2014 Teleconsultations On-line Assessments Public Health Games & Information & Promotion Entertainment Therapeutic exercises Health coaching E-Gov news & services Community news & events Digital/ Interactive TV Video clips on specific topics E-mail & Social networks Discussion groups, ‘Expert’ patient forum Weather & flooding alerts Access to the Internet E-Commerce Booking transport & appointments Video telephone Prompts & Reminders View Well-being Data for self-care © KD 2014 Future Telecare/health Home Platform SAP/NHS Records Env. Control User interface Vital Signs Monitoring Home Hub PSTN/GSM (NGN) Community Response & Support Services 1st Generation Activity Sensors & Actuators Smart Utility MeteringAlarms Service User’s “Connected” Home Telecare Centre © KD 2012 Opportunities for Service Growth • Connect with smart homes, smart meters & Internet of Things • Use mobile care to overcome landline problems • Single linked sensor with SIM solutions • Understand the ease of remote vital signs monitoring (telehealth) • Look for innovative ways of promoting self-care • Using smartphones and apps to overcome sensory issues • Change behaviour through mobile games and NUDGE theory Smart Meters There’s a telephone problem for telecare • No landline - 3 times more likely than no mobile • Next Generation Network - doesn’t support analogue units • • Cancelled - by mistake, or haven’t paid the bill • Slammed - moved to another number or Telco in error • Faults - cable theft, bad weather, JCB error • Disconnected - mistakenly unplugged from phone socket • Out of action - for days or weeks © KD 2014 Mobile Coverage in Wales EE Coverage in Wales • Cardiff was one of the first 10 cities in the UK to have 4G services that are fast-enough to have a good quality video teleconference using mobile devices • The network coverage has already extended East to Newport and includes a part of Swansea in the South, and the coastal stretch of Denbighshire and Flintshire in the North. Using Mobile Technology in the Home Reach Plus GSM Alarm Unit © KD 2014 © KD 2014 Separate Devices with Mobile Link © KD 2014 © KD 2014 © KD 2014 Personal Mobile Devices © KD 2014 © KD 2014 Features The one click button keeps you in constant contact with up to 5 loved ones whenever and wherever you are. V:Code Identity Scanning for emergency contact information. Wireless Charging so the device can be charged by simply placing on a pad, no need for fiddly wires to be plugged in © KD 2014 Web Dashboard Sample of web based user interface Mobile Dashboard Sample of mobile based user interface © KD 2014 Respexi © KD 2014 Canary - How it works: Movement Sensors Web Portal Account GUI GPRS data Home Hub • Canary is a “Kit” of three parts: • Sensors to detect movement in the home • Canary Hub - send GPRS data to server platform • Canary User Web-portal monitoring service © KD 2014 © KD 2014 Poor diet Causes of Chronic Disease Chronic Disease Epidemic Ageing Population © KD 2014 Why Is Chronic Disease Increasing? < 2.5 million years > < 100,000 years > < 50 years > © KD 2014 Two Levels of Telehealth Public health Self-care People living and working in homes, offices and factories, and making poor lifestyle choices regarding diet, use of alcohol, levels of exercise, smoking and risky behaviour Abuse of the body PREVENTIVE TELEHEALTH AND SELF-TRACKING NHS People living with £100 limiting long term £400 conditions per week Unmanaged chronic disease 50-60 months HOSPITAL AT HOME TELEHEALTH SERVICE NHS Health insurance £600 per day Emergency hospital admissions Up to £50k per annum © KD 2014 2nd Generation Telehealth Equipment © KD 2014 Non-Invasive Blood Glucose Measurement • C8 MediSensors, has received the CE Mark for their Optica • The firm’s sensor uses Raman spectroscopy to noninvasively detect glucose in blood by shining light through the skin and detecting changes in the returning spectrum. • Once the sensor is attached to the skin it sends out regular readings wirelessly over Bluetooth to a smartphone, allowing for tight glycemic control and near instant alerts when glucose levels go outside preset parameters • . It’s currently compatible with Android phones © KD 2014 Collecting Vital Signs Data for the Expert Patient © KD 2014 Temporary Tattoo Measures Vital Signs • Wearable sensors measure temperature, hydration and skin strain for to 2 weeks • Flexible electronics provide power and wireless connectivity © KD 2014 Two Levels of Telehealth Public health Self-care People living and working in homes, offices and factories, and making poor lifestyle choices regarding diet, use of alcohol, levels of exercise, smoking and risky behaviour Abuse of the body 50-60 years PREVENTIVE TELEHEALTH AND SELF-TRACKING NHS People living with £100 limiting long term £400 conditions per week Unmanaged chronic disease 50-60 months HOSPITAL AT HOME TELEHEALTH SERVICE NHS Health insurance £600 per day Emergency hospital admissions Up to £50k per annum © KD 2014 BOW BOW Devices BOdy Worn Battery-Operated Wireless device They gather data automatically & continually from the wearer. © KD 2014 Other BOW BOW Devices Attos smart shirt and pants Veristride insole Reebok Smart Cap Lumo lift Virgin Pulse Max Biovest heart monitorSensoria fitness sock Lifebeam Smart Helmet Sensoria Sports Bra Under Armour Shirt Smart U.S. Football Helmet Orvis Sensor Gloves Button Spy Camera © KD 2014 Improving Wearability - Digital Jewellery • The aesthetic form of wearable technology doesn’t compare with functional performance • Cuff is a company looking to reconcile technological prowess with head-turning looks. • Its newly-launched range of fashion accessories incorporate a discrete wireless device that, when pressed, sends a notification to your chosen contacts to let them know you're trying to make contact. © KD 2014 Practical Use of Cuff Jewellery © KD 2014 The Power of SmartPhones Features Sensors & Actuators Good processing power Microphone Large touch-screen colour display High quality speaker & headphone output Large memory Accelerometers Phone & SMS/MMS GPS & GSM location Familiar Interface options Magnetometer Lightweight & always carried Temperature chip Open platforms for innovation Camera(s) M-care “apps” explosion Vibration unit Peripheral devices available Direct inputs Prices are falling Bluetooth (LE) & WiFi Battery life is increasing Proximity sensor Suitable for different modes of operation Near Field Communications (NFC) © KD 2014 Smart Phones for Visually Impaired • Georgie has a voice -assisted touch-screen and offers apps to help complete tasks such as catching a bus and reading printed text • It was designed by blind husband-andwife Roger and Margaret Wilson • The smartphone lets users dial a number with the voice-assisted touchscreen and uses speech input to send text messages. • Other apps are available in 3 different bundles - travel, lifestyle and communication • It comes pre-loaded with a data SIM card. • Marketed by Sight and Sound Ltd of Northampton © KD 2014 Use of Apps for Behavioural Change NUDGE Principles • iNcentives - rewards for making good choices • Understanding options and benefits • Defaults - designing health interventions that people have to opt out of rather than opt into • Give feedback - let them know how well they are doing • Expect errors - offer relapse prevention strategies • Structure complex choice support weighing up pros and cons of different options • In supermarket displays, put fruit at eye level and sweet products at a lower level • In restaurants, alter the default option for sides with a main course people get salad rather than French fries or potatoes unless they specifically ask not to • At the top of a flight of stairs, show how many calories someone has burnt • In national health policy, require people to opt out of organ donation rather than having to carry a card which tells medical staff that they have opted in (this is the Welsh plan) © KD 2014 © KD 2014 © KD 2014 Support for Carers The pillbox program is just one feature of an app called Balance. It also includes sections for caregiving tips, notes for the doctor and the patient's appointments, plus a "learning section" with articles on aspects of Alzheimer's and an RSS feed for news about the disease. Allows carers to: • Organise appointments • Plan outings • Share stories • Send updates to other family members © KD 2014 Summary of Recommendations for Wales • Move quickly away from the single supplier, one-size-fits-all approach of the past to a new Welsh model based on improved assessment processes • Recognise that AT & telecare will only work if professionals are competent, confident, well-informed and well-trained • Measure outcome performance to ensure that services are delivering efficiently and effectively • Work with the NHS to develop integrated care pathways which have telecare and AT included at an early stage • Don’t stand still - technology changes VERY quickly • Seek informed, independent advice - suppliers only know about their products! • Keep talking to each other to share best practice • Be prepared to PERSUADE members of the public that our approach really does lead to improved Quality of Life THANK YOU FOR YOUR ATTENTION Any questions? [email protected] Mob: 07810797971 PLEASE CONTACT ME DIRECTLY FOR A COPY OF MY PRESENTATION