Dr. John Woolham May 2007

1. Telecare knowledge network workshop:Evaluating telecare implementation The Safe at Home Evaluation in Northamptonshire Dr. John Woolham May 2007

2. What this presentation will cover • Background to the ‘Safe at Home’ project • Objectives • Methods • Findings

3. 1. Northamptonshire’s Safe at Home project: background • Northamptonshire’s involvement in the EU funded ASTRID project • Reasons for being interested in dementia • Reasons for being interested in assistive technology • Putting principles into practice – the Safe at Home project • 3 ‘Demonstration houses’ • Three full time project workers • Project depends on • multi-agency partnership working • multi-disciplinary professional skills

4. 2. Objectives of the evaluation. • To assess the reliability of any technology used in the project • To assess the extent to which any technology used supported unpaid carers and relatives • To assess the success with which technology helps service users to maintain their independence • To examine the cost effectiveness of the project • All objectives were ‘evaluable’ within timescales and resources

5. 3. MethodsDesign • Longitudinal design – 21 months • Criteria for inclusion in evaluation: • Met criteria for referral to project • permission given to use data for research purposes • Control group from a similar Social Services Department elsewhere in the U.K. to collect outcome and cost data – not randomly assigned • No sampling. • Pre and post intervention scores

6. 3. MethodsWhat data was collected? • Data collected for evaluation also met the needs of the project. • Referral form • Assessment form (Strengths and difficulties tool) • ‘Technology review’ form • ‘Ethical review’ protocol form • MMSE data • Postal survey of carers • Management information data (hospital stays, dates of admission into care, dates of death etc).

7. 4. Findingsa.The reliability of the technology • The study identified ‘non-technical’ as well as ‘technical’ reliability issues • These findings suggest a need for a very good understanding of the social and environmental context within which the person with dementia is living and interacting.

8. 4. Findings Impact on relatives and unpaid carers • A carer stress scale was used to measure the impact of the project. In all but one item the scale score was lower (i.e. the relative or carer was less stressed) after the project had provided technology. • These changes in score were statistically significant in 9 of the 13 items on the scale (w=0.001)

9. 4. Findings On supporting independent living • Functional assessment scores for people at referral and 12 months later declined (i.e. showed evidence of slight improvement) on three of the eight sub-scales. • All sub-scale scores were statistically significant (x2=<0.001)

10. 4. Findings On supporting independent living • The control group was used to compare the rates at which people left the community. • People from the control group left the community sooner and in greater numbers: they were four times more likely to leave the community than Safe at Home users.

11. 4. Findings Note: might other factors have been responsible for keeping people living independently for longer? • The study considered if other factors might be responsible for these outcomes • The composition of the two groups: • no sampling occurred • the two groups were large and well matched on a range of factors. • Provision of care: people from the control group received: • more services, • more hours of help • more visits.

12. 4. Findings Cost effectiveness • Outcomes for both Safe at Home users and control group over 21 months were identified: these were • Service user moves away (to be close to relatives) • Admission into care • Admission into nursing care • Hospitalisation • Death. • The date - over the 21 months of the fieldwork - on which any service user left the community was also recorded, to the nearest week.

13. 6. Impact: Cost effectiveness • Lengths of time spent in institutional settings were recorded. • This enabled total nos. bed-weeks spent in residential nursing and hospital settings to be calculated over the 21 month fieldwork period.

14. What would have improved the evaluation? • Random assignment of people to control and user group • Understanding the world better from the point of view of people with dementia: how they interacted with technology and the wider social and spatial environment. • An opportunity to collect data from service users (people with dementia) directly rather than indirectly. • Following the two groups through until all had left the community. • Better financial modelling (e.g. better information about the costs of community packages & factoring these into equivalent savings figures). • Better use of call centre data

15. What was most difficult to do in the evaluation? • Data quality: management information was not of the finest • Data quality from project workers – this improved over time but required a lot of input at the start • Research ethics review. (3 sets of permissions needed • Local authority (Essex and Northants) • Northamptonshire LREC • Northampton and Kettering NHS R&D committees

16. References • Marshall, M (ed) ASTRID: A Social and Technological Response to meeting the needs of Individuals with Dementia (2000) Hawker, London. ISBN 1-874790-52-3 • Woolham, J. & Frisby, B. Building a Local Infrastructure that Supports the use of Assistive Technology in Dementia Care (2002) Research Policy & Planning Vol. 20. No.2. • Woolham, J. & Frisby, B. Using technology in dementia care (2002) in Dementia Topics for the Millennium and Beyond Benson, S. (ed) Hawker, London. • Woolham, J. Safe at Home – supporting the independence of people living with dementia by using assistive and telecare technology (Hawker, London 2005) ISBN 1-874790-77-9 • Woolham, J. (ed) Perspectives in the use of Assistive Technology in Dementia Care (Hawker, London, 2005) ISBN 1-874790-83-3 • Woolham, J. Gibson, G., & Clarke, P., Local responses to the Preventive Technology Grant: findings from a 2-stage survey of local stakeholders (published on www.atdementia.org March 2007. • Woolham, J. Gibson, G., & Clarke, P., Assistive Technology, Telecare and Dementia: Some Implications of Current Policies and Guidance (2007) Research Policy & Planning Vol. 24. No. 3.