Telecare and Single Assessment Process Mike Clark ICES Team mike@icesdoh

1. Telecare and Single Assessment ProcessMike ClarkICES Teammike@icesdoh.org January 2005

2. www.icesdoh.org Implementing Telecare • 150 social services departments, 303 PCTs, 238 district councils, housing associations, alarm service/ independent providers, demonstration facilities • 138 community equipment services – health/social services (some housing/education links) majority with S31 agreements and pooled funds, single point of contact, equipment tracking, some contracted services etc • Seven day delivery for most equipment incl telecare • Various forms of funding to date, mostly pilots/projects, £80m for 2006-2008 • Policy Collaborative, Getting Started Pack

3. www.icesdoh.org Current situation • Problems with awareness • Pilots versus mainstream • Reliability of systems, equipment • Not included in assessment and care plan options • Questions about cost-effectiveness • Through integrated equipment services or otherwise? • Capacity issues, use of alarm control centres • Resistance to new ideas, ‘Big Brother’, ethics • Concerns about charging • Limited involvement of user and carers, few direct payments

4. www.icesdoh.org Assessment including telecare • Fair Access to Care Services (FACS) – Critical, Substantial, Moderate, Low Risk • Single Assessment Process (SAP) – assessment tools – Contact, Overview, Specialist, Comprehensive • Financial assessment – if charging for services • Self-assessment • Direct payment options – social care assessment • Self-purchase

5. www.icesdoh.org Single Assessment Process (SAP) • Older Peoples NSF • Individuals atheart of assessment/care plans – timely, in proportionto needs, person-centred • Trained professionals able to use theirjudgement to best effect –integrated approach • Userconsent - copy of care planprovided • Goodinformation systems • No duplication, regardless of boundaries • Underpins range of health & social care initiatives • Care is co-ordinated

6. www.icesdoh.org Single Assessment Process (SAP) • LAC(2002)1, HSC 2002/001 –12 steps • Four assessment types – contact, overview, specialist, comprehensive • Domains – overview, comprehensive • Current Summary Record • Timetable to April 2004 and April 2005 • Statutory and other agencies involved – important contribution of GPs, housing etc to assessment • Convergence of assessment methods irrespective of tools used locally

7. www.icesdoh.org Fair Access to Care Services (FACS) • Based onrisk • Critical, substantial, moderate, lowrisk • Most social services are only operating inhigher twocategories – in some cases, only at the higher, more complex end of ‘substantial’ • Moderate and low risk –signposting, self-management, advice, information • Preventive approaches - Low/moderate often not provided

8. www.icesdoh.org Telecare and hospital admissions • Telecare has a potential role in avoiding hospital admissions as well as supporting discharges • For preventive and admission avoidance approaches you will need to look at the models of supporting long term conditions (eg heart failure, COPD) where there are multiple admissions • For hospital discharge approaches, you will need to look at intermediate care, step-up/down facilities, extra care housing etc • Reducing unnecessary hospital admissions will maintain independence for users/carers and stabilise costs particularly under the national tariff from April 2005

9. www.icesdoh.org Example of number of emergency admissions via A & E for two or more occasions during a year (27 diagnoses in LTC categories) 10% 4 or More 30% 3 or More 100% 2 or More Health Promotion LTC categories (typically 800 people per 250,000 total popln)

10. www.icesdoh.org Example of number of emergency admissions via A & E for two or more occasions during a year (27 diagnoses in LTC categories) Case Management, specialist services, assistive technology, adaptations, some telecare/telehealth 10% 30% 3 or More 100% 2 or More Health Promotion LTC categories

11. www.icesdoh.org Example of number of emergency admissions via A & E for two or more occasions during a year (27 diagnoses in LTC categories) Continuous review, coordinated services, assistive technology, adaptations, direct payments, telecare for people who live alone, telehealth for CHD, COPD etc 30% 100% 2 or More Health Promotion LTC categories

12. www.icesdoh.org Example of number of emergency admissions via A & E for two or more occasions during a year (27 diagnoses in LTC categories) Self-management, expert patient, assistive technology (preventative) direct payments, telecare/community alarms for people who live alone 100% Health Promotion LTC categories

13. www.icesdoh.org LTC model and social care provision FACS Critical Substantial Single assessment Contact Overview Specialist Comprehensive Social care (vulnerable) Health care (vulnerable) Moderate Increasing no of Evercare admissions per user Low Accessible Health & social care Information/advice

14. www.icesdoh.org Integrated health, housing and social care systems for telecare – vision • Telecare is part of a range of daily living agendas for services from security in the home to vital signs monitoring for long term conditions such as heart failure and COPD • Successful implementation will be focused on the needs of users and carers • This needs an integrated approach – there is no point in providing a telecare falls monitor if there are safety hazards around the user’s home leading to trips and falls • Care pathways may assist in ensuring that telecare is used as part of a co-ordinated care plan to support people at home

15. www.icesdoh.org Telecare – the challenge • No mainstream telecare in England yet, no joint commissioning -Telecare not provided as a care option • Single assessment still a vision rather than a reality in many areas – telecare not in CSR • 150 SSDs, 303 PCTs, 238 DCs, housing assns, alarm providers would need to be involved in assessment and care planning via SAP/FACS etc with information sharing • Paper systems too complex for SAP – must use IT • Lack of clarity over what ‘assessed needs’ to address with telecare

16. www.icesdoh.org Single point of contact Single assessment process User at home

17. www.icesdoh.org Housing Temp Phys Dis Loneliness/ isolation Falls Dementia Ageing/ Senility Stroke Single point of contact Single assessment process User at home Heart Disease LD/MH Sensory/ com loss COPD Other Phys Dis Cancer MND, MS Major Phys Dis Long term conds Integrated services to support independence

18. www.icesdoh.org Housing Temp Phys Dis Loneliness/ isolation Falls Care homes/Extra care housing Dementia Int Care Telecare Ageing/ Senility Home nursing/ADL/Adaptations Stroke Single point of contact Case management (Evercare), ADL & home nursing Chronic disease management/DTOC Telecare/telehealth Single assessment process Home nursing/ADL/Adaptations User at home Heart Disease Valuing people Supporting people LD/MH Sensory/ com loss COPD Wheelchairs/ADLs/Adaptations Care homes/telecare Continuing care DFGs Other Phys Dis Cancer Palliative care MND, MS Major Phys Dis Long term conds Integrated services to support independence

19. www.icesdoh.org Housing Temp Phys Dis Loneliness/ isolation Falls Care homes/Extra care housing Dementia Int Care Telecare Ageing/ Senility Home nursing/ADL/Adaptations Stroke Single point of contact Case management (Evercare), ADL & home nursing Chronic disease management/DTOC Telecare/telehealth Single assessment process Home nursing/ADL/Adaptations User at home Heart Disease Valuing people Supporting people LD/MH Sensory/ com loss COPD Wheelchairs/ADLs/Adaptations Care homes/telecare Continuing care DFGs Other Phys Dis Cancer Palliative care MND, MS Major Phys Dis Long term conds Integrated services to support independence

20. www.icesdoh.org Assessment Care pathway SAP Service options FACS Case Management Yes Yes Comprehen-sive? Own home? Critical? Housing Yes No No Nursing/ home care/extra care Yes Yes Substantial? Lives alone? Specialist? Yes No No Yes Yes Frequent admissions? Moderate? Overview? Int care/rehab Yes No No Yes Yes Com Alarm Telecare Vital signs Cont care? Contact? Low? No No

21. www.icesdoh.org Housing Temp Phys Dis Loneliness/ isolation Falls Care homes/Extra care housing Dementia Int Care Telecare Ageing/ Senility Home nursing/ADL/Adaptations Stroke Single point of contact Case management (Evercare), ADL & home nursing Chronic disease management/DTOC Telecare/telehealth Single assessment process Home nursing/ADL/Adaptations User at home Heart Disease Valuing people Supporting people LD/MH Sensory/ com loss COPD Wheelchairs/ADLs/Adaptations Care homes/telecare Continuing care DFGs Other Phys Dis Cancer Palliative care MND, MS Major Phys Dis Long term conds Integrated services to support independence

22. www.icesdoh.org Housing Temp Phys Dis Loneliness/ isolation Care pathway Falls Care homes/Extra care housing Dementia Int Care Telecare Ageing/ Senility Home nursing/ADL/Adaptations Stroke Single point of contact Case management (Evercare), ADL & home nursing Chronic disease management/DTOC Telecare/telehealth Single assessment process Home nursing/ADL/Adaptations User at home Heart Disease Valuing people Supporting people LD/MH Sensory/ com loss COPD Wheelchairs/ADLs/Adaptations Care homes/telecare Continuing care DFGs Other Phys Dis Cancer Palliative care MND, MS Major Phys Dis Long term conds Integrated services to support independence

23. www.icesdoh.org Assessment Care pathway SAP Services FACS Case Management Yes Yes Comprehen-sive? Isolated/lonely Wandering? Critical? Falls Housing Demetia Yes No No Nursing/ home care/ specialist dementia care & support Yes Yes Substantial? Lives alone? Specialist? Yes No No Yes Yes >1 fall per month? Moderate? Overview? Int care/rehab Yes No No Telecare/ telehealth – falls monitor, reminders, wandering, bed occupancy etc Yes Yes 3 or more admissions? Contact? Low? No No

24. www.icesdoh.org Further information • ICES Team – www.icesdoh.org • Change Agent Team - http://www.changeagentteam.org.uk • Audit Commission - http://www.audit-commission.gov.uk • Rachel Denton (telecare lead, ICES) – rachel@icesdoh.org • Mike Clark (telecare pack) – mike@icesdoh.org • Ian Salt – (ICES Director) – ian@icesdoh.org • Steve Hards – (DH, Policy Collaborative) - Steve.Hards@dh.gsi.gov.uk • Telecare pack - www.icesdoh.org/telecare • Policy Collaborative: http://www.info.doh.gov.uk/etpc/etpc.nsf