An integrated approach to delivering successful Re-ablement and Telecare services

1. An integrated approach to delivering successful Re-ablement and Telecare services Housing LIN annual conference 12th December 2012

2. Your speakers today… Kevin AldersonHealth & Social Care Policy Director Tunstall Healthcare (UK) Ltd Linda SandersCorporate Director, Social Care & HealthLondon Borough of Hillingdon

3. What we will cover • Introduction • What is Telehealthcare? • Kevin Alderson • Hillingdon Case Study • Linda Sanders • Q & A • Everyone!!!

4. Background – the “P’s” • Personalisation • Prevention • Pound notes!!

5. Background – the “I’s” • Independence • Integration • Innovation

6. Finally… the “T’s” • Transformation • Technology • Telehealthcare • Tackling the problem • More demand, less money

7. Summary • Partnership working • “the way to get the car moving” • Telehealthcare technology • “the oil in the engine”

8. What is Telehealthcare?

9. Telecare Service Telecare units and Sensors in clients’ homes Monitoring Centre Response in the Community Free phone telephone number Monitoring Centre can support: Administration duties, Emergency response coordination Lifestyle monitoring Quantify results, Coordinate installation and removal, Equipment inventory Valuable communication hub for the whole service Based in client homes Extra care housing Residential housing Nursing homes etc.

10. Telehealth Service Telehealth monitors in patients’ homes Monitoring Centre Clinicians, Community and Trust based Free phone telephone number Monitoring Centre can support: Administration duties, Non clinical triage Quantify results, Coordinate installation and removal, Infection control Equipment inventory Valuable communication hub for the whole service Clinicians perform daily triage of patient caseload Based in patient homes Extra care housing Residential housing Nursing homes etc.

11. Tunstall LifeCare

12. Caring for mum with dementia • Barbara is in her 80s, has moderate dementia and lives alone. • She had been walking away from her home during the night and her family had been keeping a close watch on her and escorting her home on occasions. • In addition she had been leaving pans on the cooker unattended • This was causing a great deal of stress for her daughter and the rest of her family. • THE SOLUTION • A telecare package was installed including a “property exit sensor” which sent an alert to the 24 hr Careline. • The operators managed to reassure Barbara and encourage her to shut the door and come back into the house 87 times in a 3 month period. • Only on 3 occasions were the family called out. • THE OUTCOME • “Since telecare, I have started to go out again and spend time with ALL my family, and I know Mum will be ok. The equipment really gives me peace of mind.”

13. Stephen – telecare has enabled independence • Stephen in his early 20s has epilepsy and suffers around 1-2 seizures a week usually at night • His mother wants him to live at home and he wants his independence THE SOLUTION • We installed a telecare epilepsy package: • epilepsy sensor placed in the bed to alert of seizures at night • fall detector (body worn device) for during the day • Both would send an alert to mum (and 24 hour monitoring centre) so she could go to her son’s aid and provide the necessary medication, should he have a seizure. THE OUTCOME “I was so pleased with telecare, I agreed to Stephen getting his own flat near the family home.” Stephen’s mum

14. Caring for children with Disabilities • Tehream is a single mum who cares for her 2 sons, (7 & 12), who are severely autistic and profoundly deaf • Her younger child is currently in foster care with regular home visits • Tehream has not had a full night’s sleep for ten years and was finding it increasingly difficult to manage as her son grows bigger and stronger • She could not have a cooker as the children have an extremely high pain threshold and are at risk of injuring themselves • Her eldest son left the bath running and flooded the kitchen and both are prone to leaving the house by the windows and doors, causing danger to themselves

15. Caring for children with Disabilities Bed sensor under-pillow vibrator Carer Pager Property exit Home unit Flood Smoke • THE SOLUTION • A telecare solution that allows Tehream to know as soon as an incident occurs, via a pager during the day and the under pillow vibrator at night. • THE OUTCOME • “I have been able to get a good night’s sleep for the first time in many years, as I no longer have to stay awake at night worrying about my sons’ activities. I also know I’m not completely alone in caring for my children. They would both be in foster care if it wasn’t for telecare.”

16. Telehealth – Patient’s Comments “Despite only having the unit for a couple of months, it has already saved me three admissions to hospital. After various abnormal readings my doctor diagnosed a chest infection and I was prescribed antibiotics. Before Telehealth I would have left it too long causing my condition to deteriorate and would eventually ended up in hospital.” A Telehealth unit was fitted in Pauline’s home in December 2009. “Telehealth saved me an admission to hospital between Christmas and New Year, when there was an abnormal reading on Boxing Day and the following two days. I was really grateful as having to go to hospital would have really spoilt my Christmas.” A Telehealth unit was fitted in John’s home in March 2010

17. And don’t forget the carers… John's wife said: “Before we had the Telehealth fitted I was constantly worrying about John. I would never leave him alone in the house in case he became unwell. “Not only has Telehealth improved John's quality of life, it has benefited mine too. I now have more freedom and can pop into town for a couple hours, knowing he is safe. I feel a sense of reassurance knowing that if John feels unwell he can take a reading and speak to the doctor over the phone. I would definitely recommend Telehealth, it has so many benefits and not just for patients, but also for those caring for them.”

18. Telehealthcare Solutions are Highly Adaptive Conditions Arising From Ageing Help remotely protect, support and respond to age-related conditions Chronic Diseases Sophisticated health status and vital signs monitoring to enable individuals to be cared for in their homes Mental Health Help those who suffer panic attacks or phobias to know they can contact someone immediately Dementia Help to manage and monitor environmental risks Telehealthcare Solutions Physical Disabilities & Sensory Impairment Help users react to alerts and stay in touch with carers Learning Disabilities Manage the safety and security risks

19. Integrating telehealthcare across health and social care brings significant benefits • Benefits to social care provision include: •  Need for residential/ institutional care (either avoidance or delay) •  Requirement for home or day care •  Additional supported living costs • Benefits to health care provision include: •  Hospital admissions (e.g. falls), A&E visits and 999 call-outs •  Early discharge and avoidance of delayed transfers of care •  Continuing health care/nursing care • Benefits to end users include: •  Ability to live at home independently and for longer •  Quality of life, choice of care and mobility; control •  Anxiety • Benefits to carers include: •  Peace of mind and degree of independence •  Quality of life & respite opportunities •  Quality of assessments

20. Summary • Partnership working • “the way to get the car moving” • Telehealthcare technology • “the oil in the engine”

21. An integrated approach to delivering successful Re-ablement and Telecare services  Linda Sanders, Corporate Director Social Care & Health Housing LIN annual conference 12th December 2012

22. Strategy • To reduce the reliance on long-term residential/nursing placements, enabling people to remain living in their own homes rather than be placed in institutional care • Increase community and supported living opportunities to enable greater independence for existing long term service users • Enabled through: • Effectively mainstreaming telecare and re-ablement services, as part of transforming the approach to social care • Co-ordinated approach to developing housing solutions that provide increased supported living capacity

23. Key transformation targets • Savings target of £8.5m by end of 2012/13 for ASC • 3000 new telecare users by the end of 2014/15 • 422 new supported housing units over 4 years - 225 Council and 197 RSL

24. Expected outcomes Combination of: • Preventing/delaying entry into residential care • Preventing people needing on-going care • Reducing the level of dependence for individuals already supported through social care services • Support confidence building during re-ablement process

25. Hillingdon’s new customer pathway • Maximising the impact of Re-ablement • Mainstream the telecare offer – LBH service is branded as TeleCareLine • TeleCareLine used to facilitate maximum independence in extra care, supported living & residential services • Integrated team of support for clients transitioning to supported living/extra care arrangements • Comprehensive housing development programme focusing on all levels of need, combination of new build and developing of existing provision

26. Results so far • Reduction in long-term residential and nursing care placements from 8.08 per week in 2010 to less than 4 per week over last 18 months • For 2011/12 to 2012/13 - saving achieved of £2.3M across 93 service users spanning all client groups through transition to range of supported living arrangements, with a further £530K cost avoidance saving from 41 service users over the same period • Residential/nursing placement headcount at its lowest for 6 years. With a reduction of 119 OPS placements (18%) from October 2010 • A combination of re-ablement and telecare has contributed to a £300K reduction in forecast spend on homecare hours for 2012/13 from period 1 to 7 • 1,993 new TeleCareLine installations from April 2011 to November 2012

27. What are we doing in practice • TeleCareLine & Re-ablement to support individuals already in the community or to assist them back home after hospital/respite/rehabilitation – case study handouts • TeleCareLine in Extra Care & Supported Living • TeleCareLine in Learning Disability In-House Residential Service

28. Early indicators from TeleCareLine evaluation Detailed analysis of sample of new TeleCareLine service users during 2011/12: • 195 clients reviewed – all with enhanced package of support • 48% of cases are considered to be assisting in delaying the demand for further services • 10% have enabled a delay in residential care placements • 42% have facilitated a smaller homecare package These clients will be tracked and figures updated at the end of 2012/13

29. How we have made it work • Strong strategy and vision, with political and senior leadership • Effective partnership working includes health, housing, care providers and voluntary sector • Clear internal process – infrastructure in place • Project management approach to both transitioning support arrangements for existing service users and improving the pathway for new referrals • Efficient business processes - clearly communicated to both staff and residents on a regular basis • Ongoing PR/communications programme, focusing on all key stakeholders including the internal workforce

30. “Hearts and minds” • Changing the way we engage with service users and the support we provide. • Commissioning and developing effective provision & services to support individuals in new ways • Reviewing/challenging how we use existing resources, utilising partnerships effectively • Staff and service users – key stakeholders, dedicated activity to engage both for success • Building commitment with health partners to develop Telehealth solution

31. Additional resources • Guardian article about the Hillingdon experience • http://www.guardian.co.uk/social-care-network/2012/nov/27/telecare-delivering-savings-hillingdon?INTCMP=SRCH • Financial analysis paper will be available soon through the Hillingdon website

32. Thank you

33. Discussion Section • Any questions? • Any comments? • What is the role of Housing within integrated care?