4. PRACTICE ISSUE FOUR: Innovations
The Joint Improvement Team in Scotland funded a national development programme for Telecare that was launched in August 2006. An evaluation of the first two years of the programme found that not only did telecare save money, but it improved the quality of life of service users and their carers (Scottish Government, 2009). Over 13,000 bed days and 61,000 care home days were saved.
A growing body of literature has emerged in relation to the ethics of telecare (Eccles, 2010). While telecare has the potential to be of considerable benefit, a number of concerns have emerged. These relate to the privacy and freedom of the individual and the potential that telecare has to reduce human contact, resulting in greater social isolation.
The attitudes of older people towards technology are crucial to its success or otherwise (McCreadie and Tinker, 2005). Willingness to use technology is based on a complex mix of factors including felt need, access to technology, attributes of the technology such as efficiency, and reliability and acceptability. The felt need for support was found to be more important than chronological age in terms of accepting the technology.
An overview of the evidence base for the successful implementation of telecare was published by CSIP in 2006. The study found some evidence of effective outcomes for service users in relation to vital signs monitoring equipment and information, advice and support, but almost no evidence that safety, security and monitoring equipment was effective in reducing costs or in achieving improved outcomes.
This systematic review of home Telecare for frail older people and other patients with chronic conditions searched 17 databases and found 68 randomised control trials and 30 observational studies of interest. The review found that the most effective telecare interventions appear to be automated vital signs monitoring (for reducing health service use) and telephone follow up by nurses (for improving clinical indicators and reducing health service use). The cost-effectiveness of the interventions was less certain. There appeared to be insufficient evidence about the effects of home safety and security alert systems.
Barlow J et al (2007) A systematic review of the benefits of home telecare for frail elderly people and those with long term conditions Journal of Telemedicine and Telecare 13 (4): 172-179
The service aims to maximise independence by increasing personal and environmental safety, enabling the recipient to live in their own home for as long as possible. Equipment is linked to trained advisors who respond to calls for help. The equipment ensures access to help when it is most needed. The service can be offered as part of larger packages of support.
West Lothian Home Safety Service
For telecare to be effective:
- Packages need to be person-centred
- Should be provided as part of a broader community care package rather than as a stand alone service to prevent social isolation
- Effective back up services need to be available in order that additional pressures are not put on carers
- Service users should be able to pilot equipment to ensure it meets their needs.