Liverpool Telecare Pilot from a Clinicians Point of View Meduse Conference Utrecht September 2007

Why it is Important to Maintain People in Their Own Homes? Changing the environment of people with dementia/memory problems to a ‘safer’ place e.g. sheltered housing or residential care can cause more problems than it solves :-

Increased level of confusion/disorientation as they are unable to recognise the new environment or remember why they have moved. Distress at having to give up many familiar possessions as the new accommodation is likely to be smaller Increased rather than decreased stress on the family as they feel guilty seeing their loved one unhappy.

It is a recognised fact that being in familiar surroundings with established routines helps to minimise the effects of dementia

It is a known fact that people are living longer resulting in more people requiring support at the same time there is a reduction in the number of facilities available in which support is provided. Many older people go into care reluctantly because they do not want to be a burden on their families

Having this type of system in place not only gives the family peace of mind but also the older person feels more confident living on their own knowing that if anything untoward was to happen help would be summoned for them

Use of Daily Profiles Daily profiles were useful for identifying sudden changes in behaviour patterns i.e. More frequent visits to the toilet could indicate a urine infection. A person with memory problems may not recognise this is happening and as a result would not tell carers. Any infection will cause an increase in confusion

Change in movement patterns could indicate reduced mobility due to physical problems or:- Lack of motivation to carry out tasks Inability to initiate the task Increased disorientation in time and as a result not recognising the need to get up from the chair to prepare food or go to bed etc.

Intelligent Wellbeing Where the daily profiles were useful in identifying immediate changes in behaviour the intelligent wellbeing system allowed us to identify slower, long term changes in behaviour or ability to perform everyday tasks. When visiting a person for an hour once per week its difficult to detect small changes e.g.

A decrease in the use of water in the bathroom may indicate reduced standard of personal hygiene, which could have an effect on physical health. An increase in the time spent in the kitchen around the cooker and kettle could indicate increasing difficulty preparing meals and drinks.

Being able to see the changes over several months in the form of a graph enabled us to increase the level of support as it was required rather than waiting for a crisis situation to develop.

Concerns The main concerns raised by potential service users and their families were:- Telecare would replace the need for personal contact. Invasion of privacy and loss of patient confidentiality.

The main concerns from a professional point of view were:- How older people with mental health problems (including memory problems) would react to a telephone call telling them that they had left their front door open etc. What would happen to these people when the pilot ended, would there be something to replace it?

Who Benefits Service users Carers Professionals

Service Users Service users are the main beneficiaries of telecare services:- They have the opportunity to remain in familiar surroundings for much longer They maintain a level of independence with the added confidence of knowing that should anything happen help will arrive quickly.

Carers Families benefit from the peace of mind knowing that if anything should happen to their loved one they would know almost immediately and the situation could be dealt with. Many said that they could sleep better at night knowing the system was in place.

Professionals From a professional point of view any service that helps maintain people in their own homes safely is of value, and being able to monitor daily activities if we have concerns about how somebody is coping enables us to deal more efficiently when difficulties arise.

Liverpool Telecare Today Liverpool City Council now has a Telecare Team which consists of:- A Telecare lead A team of 3 Telecare Assessors (1full time, 2part time) A smart flat for demonstration purposes

Aims To provide assessment and installation of a telecare system to between 250 and 300 older people in Liverpool by end of March This will be funded from the Preventative Technology Grant. The Service will then be put out for tender.

Target Groups Early Dementia History of Falls Hospital Discharge Discharges from Intermediate Care People visited by the Mobile Nights back to bed service

Quality or Quantity The current telecare system is not as comprehensive as the pilot was but it is felt that more people would be able to benefit from a scaled down version, which costs less to install and monitor.

Thank you Barbara Frost