Outcomes for Older Telecare Recipients: The Importance of Assessments

The article explores both telecare in relation to its composition of assistive technologies, including sensors; and associated services that use such technologies as a means by which, often vulnerable, people can obtain help through their activation - with signals being routed to monitoring centres. The context is one where there are changes to such technologies and ongoing growth in the use of telecare services - despite there being no indicated benefits from a major study (the Whole System Demonstrators). The 'curious' investment in such technologies and services by Adult Social Care Departments in England is investigated through an interview survey that elicited over 100 valid responses. Iy gave particular attention to the assessment process by which effective targeting (to those who would be most likely to benefit) would, it had been assumed, have taken place. Key outcomes point to needed improvements to social care practice - including the need to balance a narrow focus on risk (determined in a largely top-down way) with other telecare offerings that could more proactively address (e.g. loneliness) and involve the user more proactively in relation to technology and service options. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Summary This article explores the role of telecare assessment, review and staff training in meeting the needs of older people living at home. Using original empirical data obtained from an online survey of English local authorities it reveals considerable variation in assessment and review practice and in training given to social work and other staff who assess and review, which may impact on outcomes for telecare users. The study findings are situated within an English policy context and earlier findings from a large, government funded randomised controlled trial. This trial concluded that telecare did not lead to better outcomes for users. Findings Our survey findings suggest that it may be the way in which telecare is used, rather than telecare itself that shapes outcomes for people who use it, and that ‘sub-optimal’ outcomes from telecare may be linked to how telecare is adopted, adapted and used; and that this is influenced by staff training, telecare availability and a failure to regard telecare as a complex intervention. Application The findings may help to reconcile evidence which suggests that telecare does not deliver better outcomes and local authority responses to this which either discount or contest its value. The article suggests that to use telecare to achieve optimal outcomes for older people, social workers, care managers and other professionals involved in assessing for telecare will need to be given enhanced training opportunities, and their employers will need to perceive telecare as a complex intervention rather than simply a ‘plug and play’ solution

Knowledge and Skills Sets for Telecare Service Staff in the Context of Digital Health

Telecare services have an established place within the United Kingdom. Through using online technologies to help mostly older people to remain at home, they are recognised as having a support role for health as well as social care. This positions telecare services within the broader realm of ‘digital health’. As that position becomes more embedded, it poses questions about the nature of tasks that are (or should be) undertaken by telecare staff, and regarding the knowledge and skills that are required. A convergence of telecare and telehealth services is indicated together with a need for some kind of accord or accommodation. This paper summarises the United Kingdom policy context; references the technologies that are provided by telecare services or can be linked to them; notes briefly the impact of the COVID-19 pandemic; and proposes six knowledge and skills sets. Outcomes of the UTOPIA study undertaken in England from 2016 to 2017 are drawn upon: this study provided important information from over 100 local authority telecare managers.   &nbsp

Using GPS Safer walking technology to promote identity and well-being through engagement in meaningful outdoor occupations

More now, than ever before, we are aware that spending time in outdoor natural environments and maintaining connections to nature are important to our health and well-being. Yet, access to the outdoors is sometimes limited for people living with dementia because of concerns about the risks of them becoming lost, particularly in natural outdoor environments such as woodland and green open spaces. This can prevent people with dementia engaging in meaningful activities outdoors and lead to a reduced quality of life. In the UK, safer walking technology is increasingly being used by people with dementia to access the outdoor environment, (Wood, Woolham and Ward 2015). This new research from Coventry University explores the use of this technology, through the lived experience of both people living with dementia and family carers

Experiences of adult social work addressing self-neglect during the Covid-19 pandemic

Summary : Internationally there has been much interest in the impact of the COVID-19 pandemic on the care and support of older people including those with needs arising from self-neglect and/or hoarding. During the pandemic English local authorities’ legal duties remained to respond to concerns about harm about people with care and support needs living in the community. This paper reports interviews with 44 participants working for adult safeguarding/adult protective services (APS) in 31 local authorities recruited from all English regions. Interviews took place online in November-December 2020 as the pandemic's second UK wave was emerging. Analytic induction methods were used to develop themes. Findings : Participants reported some of the variations in referrals to their services with more contact being received from community sources concerned about their neighbours’ welfare. Participants provided accounts of the local organisation of adult safeguarding services during the pandemic, including in some areas the potential for offering early help to older people at risk of harm from self-neglect or hoarding behaviour. Online inter-agency meetings were positively received but were acknowledged to potentially exclude some older people. Applications : This article reports observations from adult safeguarding practitioners about their services which may be of interest internationally and in renewing services that can sustain public interest in the welfare of their older citizens and in developing early help. The findings reflect those from children's services where online meetings are also predicted to enhance professional communications post-pandemic but similarly need to ensure effective engagement with service users and their families

Telecare at a crossroads? Finding researchable questions

Purpose This paper aims to report on a structured attempt to develop new directions for research into telecare. Current research evidence suggests that telecare in the UK is not optimally cost-effective and does not deliver better outcomes than more traditional forms of care and support. To address this problem, an analysis of expert opinion about future directions for research is provided. Design/methodology/approach Two electronic surveys of UK based academic experts were conducted. Participants were drawn from a range of professional disciplines, including medicine, social care, occupational therapy and social policy and identified were by their contribution in this, or allied fields. The first survey included nine questions intended to identify at least one new research question that could form the basis of a funding proposal to the Nuffield Foundation, which provided “seedcorn” funding to support this work. Ten themes were identified following thematic analysis. The second survey asked participants to prioritise three of these themes. Findings Key themes emerging as priority areas for future research were as follows: the role of assessment in ensuring technology deployment meets the needs of service users; ethical implications of technology and how these might be addressed in the future; and the use of end user co-production/co-creation approaches in the development of new assistive technologies and digital enabled care. Research limitations/implications The findings are based on academic expert opinion; perspectives of practitioners, service users and family members are unrepresented. Practical implications The findings of this study could contribute to development of new directions for telecare research, and future strategic funding decisions in this rapidly changing field. Originality/value Evidence for sub-optimal outcomes for telecare requires new thinking. The authors are not aware of any other study that offers an analysis of expert opinion of fruitful areas for new research into telecare

Caring in Covid-19: Personal Assistants’ Changing Relationships with their Clients’ Family Members

Context: The impact of Covid-19 on people working as personal assistants (PAs) or directly employed care workers potentially affects not only themselves and their clients but sometimes clients’ family members or carers. Objectives: This interview-based study aimed to hear directly from PAs of their experiences during the pandemic to inform policy and practice. Methods: A sample of 41 PAs working in England were interviewed by telephone during the early months of Covid-19 (April–June 2020) in England. Interview data were analysed thematically and accounts of PAs’ engagement with their clients’ family members were explored. Findings: Study findings illustrate the fluidity of relationships at this time within four dimensions: 1) some family members working more closely with PAs, 2) the development of tensions between PAs and family members, 3) displacement by family members of PAs and other care services, 4) PA accounts of working with clients who had little or no family contact or other assistance during the pandemic. Limitations: This study did not interview family members to hear their views of the relationships and circumstances discussed by the PAs. Implications for research include a need to hear from other care workers operating as live-in PAs and from family members and employers and to follow-up with PAs as the pandemic progressed. Policy implications include the need to encourage contingency planning and to ensure support for PAs. Practice implications are for staff responsible for individualised funding to ensure PAs are known to their systems to enable their support

Making Use of Evidence in Commissioning Practice: Insights into the Understanding of a Telecare Study’s Findings

The paper draws on (100+) survey responses from social services authorities in England. It established their generally minimal understandings of (largely negative) outcomes of the government promoted (Whole System Demonstrator (WSD) project. The WSD project involved over 5000 mainly older people - half of whom were, following assessment, assigned telecare equipment (others telehealth). The robustness of the outcomes are discussed; issues about the effectiveness of assessments are raised; and the appropriateness of the methodology (an RCT) is questioned. In sum the paper provides an example where shortcomings of RCTs are exposed in a context where technological changes impact on ‘traditional’ (health and) social care service frameworks. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.In less than a generation, telecare has become a significant new resource for local authority (LA) Adult Social Care Departments (ASCDs) in England and other European countries to offer to people eligible for social care and support. All English ASCDs either have directly managed, or commissioned, telecare services, and telecare is often used as a 'first line' service (that is, before other forms of intervention). The Whole Systems Demonstrator Project (WSD), a very large clinical trial funded by the English Department of Health (DH) concluded that it does not deliver better outcomes. Despite this, and in the context of unprecedented reductions in adult social care expenditure over the last decade (Innes and Tetlow, 2015), investment in telecare has continued in the UK. This article explores the extent and nature of the evidence used in LAs to support investment in telecare