Developing Telecare in an Intermediate Care setting – the Aberdeen experience Dorothy Askew

1. Developing Telecare in an Intermediate Care setting – the Aberdeen experience Dorothy Askew (Community Care Strategy Officer, Aberdeen City Council) Wendy Churcher (Telecare Development Officer, Aberdeen City Council)

2. Overview of today’s presentation: • Strategic context • The challenges ahead • The links between Telecare and Intermediate Care • Examples of “out of hospital” initiatives • Examples of case studies utilising Telecare as an option (plus group discussion) • Building on our experience to take things forward - what has worked well, issues and challenges 1

3. Strategic Context • National Telecare Programme (2006) • “Seizing the Opportunity: Telecare Strategy 2008-2010” • Review of Sheltered Housing in Scotland (2008) • Better Health, Better Care (2007) • Managing Long-term Conditions (2007) • Delivering for Health (2005) • Shifting the Balance of Care Agenda • Development of the Dementia Strategy for Scotland 2

4. Challenges we face.... • Ageing population • Shrinking workforce • Shifting the balance of care ... finding a new way of working 3

5. National Telecare Programme Funding Allocations • Launched in August 2006 • Allocations for 2 initial year period • £266,174 • 2008/09 funding - £125,000 • 2009/10 funding - £100,000 4

6. A Telecare Strategy for Aberdeen… • Prevention and early intervention, so that people can remain in the community for longer, maximising independence and dignity • Awareness raising and information for current and future service users, carers and professionals • Maximising opportunities to mainstream Telecare by ensuring that it is integral part of service planning and design 5

7. Our Objectives • Reduction in the number of avoidable admissions to hospital or care homes • Contribute to the reduction in delayed discharge cases • Reduce the need for more expensive interventions • Reduce the pressure on informal carers 6

8. What we’ve done so far... • Established a multidisciplinary Telecare Steering Group & worked with the Grampian Telecare Practitioners Group • Developed an interim eligibility criteria and charging policy • Produced a web-based Information Pack • Developed Telecare website pages • Distributed “taster kits” across key locations • Delivered awareness raising sessions • Appointed Telecare Development Officer • Links with the Grampian Intermediate Care Project 7

9. Links to Intermediate Care • Intermediate Care is an umbrella term for a range of services that aim to improve independence through timely provision of rehabilitation and care. • The aim of the Aberdeen Intermediate Care Project has been to improve independence through the provision of rehabilitation and care at home or in a care/rehabilitation setting. • Key factors for success mean creating services that promote faster recovery from illness, where possible prevent unnecessary hospital admissions, support timely discharge from hospital and promote independent living. 8

10. Intermediate Care in Grampian • Link to NHS Grampian “Health fit” principles to ensure future patients who need acute specialist care are able to obtain timely access to acute care at Aberdeen Royal Infirmary and Dr. Gray’s Hospital. • Patients who need intermediate care to continue their care in a community hospital, rehabilitation setting or with appropriate support in their own home. • Need to develop range of “community hospital” and “out of hospital” services for each community health partnership area in Grampian (Aberdeen city, Aberdeenshire & Moray). 9

11. Intermediate Care in Aberdeen city Three key areas: • Relocate acute geriatric medicine service from Woodend Hospital to co-location (ARI). Benefits: All patients, irrespective of age, will have equal access to specialist services at the acute hospital site. 2.Creation of Aberdeen Community Hospital Benefits: Allow patients who have completed specialist acute element of care but need period of in-patient rehabilitation to move to community hospital setting & participate in rehab programme prior to discharge. 3. Creation of a range of “out of hospital” initiatives. Benefits: Minimise the need for admission and facilitate early discharge. 10

12. “Out of Hospital initiatives” - the links to Telehealthcare development- some examples Aberdeen Community Geriatrician Service: • Consultant geriatricians aligned to general practices – gives GP’s the opportunity to ask advice/discuss the clinical care of their patients with the linked geriatrician. Telecare links: Raising GP awareness of potential use of Telecare/signposting for support & advice. 11

13. “Out of Hospital initiatives” - the links to Telehealthcare development- some examples Early Supported discharge (in development): • A supported discharge service– a package for 4-6 weeks following discharge when a rehabilitation team visit a patient to continue their rehabilitation in their own home. (initially for stroke/orthopaedic patients but once established should be available for all patients over 65 in the city who fulfil the referral criteria). Telecare links: This now in place at Smithfield Court where Telecare has been considered as part of the infrastructure/link into training of professionals of Telecare potential/opportunities to implement Telecare options for patients. 12

14. “Out of Hospital initiatives” - the links to Telehealthcare development - some examples • Chronic Obstructive Pulmonary Disease pilot (in development): • The risk algorithm, Scottish Patients At risk of Admission and Readmission (SPARRA) demonstrates that approx 50% of all patients in Scotland who are risk of repeated hospital admissions have COPD. • Pilot to find out if the use of specific Telehealth monitoring of patients in their own home can help in the management of acute episodes and for some, reduce the need for hospital admission or reduce the length of stay in hospital. • Funding from Scottish Government eHealth project - pilot being developed in partnership between NHS Grampian and Aberdeen City Council. 13

15. “Out of Hospital initiatives” - the links to Telehealthcare development- some examples Social Care Rehabilitation: Rosewell House • Rosewell House is a new 60-bedded care facility built by Aberdeen City Council (ACC) and NHS Grampian. The 60 places comprise 20 residential places, 20 respite places and 20 ‘social care’ rehabilitation places. • The aim of the unit is to increase independence and reduce dependency through rehabilitation for adults with physical, social, communication and/or sensory difficulties, and/or mild cognitive impairment. • Telecare links: Rosewell House has a fully functioning Tunstall system built into the infrastructure of the building. In addition to this, Telecare is considered as part of the holistic assessment of need undertaken prior to discharge. 14

16. “Out of Hospital initiatives” - the links to Telehealthcare development- some examples Social Care Rehabilitation: Smithfield Court Smithfield Court is a joint health, housing and social work service. We provide rehabilitation, assessment, care and confidence-building activities to individuals for varying periods of time. This is generally between 4 to 8 weeks. The activities aimed at promoting independence are provided in 20 self-contained flats that are based within a sheltered housing complex. The rehabilitation team comprises of carers, a community nurse, occupational therapy staff, physiotherapy staff and a care co-ordinator. • Telecare links: The building is equipped with a warden call system, which is being upgraded through our replacement scheme to a system that enables the use of Telecare overlays. We have provided access to the Just Checking System to enable staff to monitor and assess lifestyle issues following discharge and as before the multidisciplinary team should address Telecare requirements as part of the holistic assessment process. 15

17. “Out of Hospital initiatives” - the links to Telehealthcare development- some examples Social Care Rehabilitation: Craig Court Young adult’s unit (16-65 years) with 6 long stay and 10 rehabilitation places to provide rehab to develop skills required to live independently following an acquired brain injury, stroke or spinal injury. • Telecare links: The unit has a nurse call system. Telecare assessment is part of the holistic assessment, which takes place as part of the discharge planning process. 16

18. Building Telecare into the infrastructure…. • LD services (Dubford, Balnagask, etc) • Coronation Court • Holland Street • Urquhart Road • Warden Call upgrade (BT21CN) 17

19. Case Studies.... 18

20. Case Study 1 • “Susan’s Story” an example of how we are using Telecare to support the Citizens of Aberdeen. Medication Reminder Epilepsysensor 19

21. Case Study 2 • “Archie’s Story” followed by a discussion on how Aberdeen are using Just Checking to support people with dementia. 20

22. Case Study 3 • Jean’s Story • How Buddi is being used to support people with dementia in Aberdeen. 21

23. Practical experiences of using Telecare in an intermediate care setting to support people with dementia: • What has worked well • Issues • Challenges 22

24. Next steps in Telecare development • Utilising the expertise in the JIT document “Implementing Telecare: An Action Guide” to consider through a phased approach: • Undertake a review to help understand: • - What is working well & areas of good practice. • - What aspects are not working as well along with the issues & • barriers to progress. • - Potential options to change &/or improve Telecare provision in • Aberdeen (also identify & link to gaps in service where • relevant). • - How to ensure service users & carers needs are being taken • into account. • - Ways to secure better use of mainstream community care • service provision through the development of Telecare. • - How we can work together better to achieve results. • - What are the barriers to achieving all of the above & how we • can plan to break these down. 23

25. Next steps in Telecare development • Action planning likely to incorporate the following areas of work: • Governance • Strategic & project planning • Stakeholder involvement and • communication • Resources • Operational arrangements 24

26. Contact details Dorothy Askew Community Care Strategy Officer, Aberdeen City Council Tel: 01224 538042 Email: daskew@aberdeencity.gov.uk Wendy Churcher Telecare Development Officer, Aberdeen City Council Tel: 01224 264209 Email: wchurcher@aberdeencity.gov.uk Aberdeen City Council website: www.aberdeencity.gov.uk 25