SMART technology in housing, health and care

1. SMART technology in housing, health and care Grahame Blair, Head of Social Policy Lynn McAllister, Group Manager West Lothian Council

2. West Lothian Context - demographicsTable 1: Numbers of people over 60 projected for West Lothian 2005 - 2018 Age group 2005 2012 2018 Rate of increase 60 -69 15,164 18,260 19,205 27% 70 - 79 8,952 11,022 13,715 35% 80+ 4,287 5,292 6,756 58% Total 28,403 34,574 39,676 40% WL % population 164,367 174,763 183,646 % 60+ population 17% 20% 22% This table shows the growth of 40% in terms of over 60s in West Lothian over a 15 year period. In particular, the largest percentage increase is in the over 80 population, who we know make the highest demand on care and health resources. As a result, we have had to look at better ways of providing care and support to our older people, as we do not anticipate that the resources available to us will grow at the same rate.This table shows the growth of 40% in terms of over 60s in West Lothian over a 15 year period. In particular, the largest percentage increase is in the over 80 population, who we know make the highest demand on care and health resources. As a result, we have had to look at better ways of providing care and support to our older people, as we do not anticipate that the resources available to us will grow at the same rate.

3. West Lothian context - background information Around 165,000 residents, currently relatively young, but rising quickly in terms of older people Mix of urban and semi-rural population 10th largest local authority in Scotland 1200 staff in Social Policy West Lothian is located in Scotland’s central belt. While the population is currently younger than average, the proportion of older people within the population will grow rapidly over the next few years. West Lothian Council covers the 10th largest population in Scotland. There are 1200 staff employed in the service area providing care and support to all client groups.West Lothian is located in Scotland’s central belt. While the population is currently younger than average, the proportion of older people within the population will grow rapidly over the next few years. West Lothian Council covers the 10th largest population in Scotland. There are 1200 staff employed in the service area providing care and support to all client groups.

4. System Redesign Replaced Council care home provision with combination of Housing with Care units and care home provision Demolished 4 Old People’s Homes, built 2 new care homes with health, 5 new Housing with Care units Fitted 2800 households in the community with assistive technology Established team capable of assistive technology assessment, installation and response Modernised our Home Care Service into a Personal Care Service Introduced new meals and shopping delivery services Simplified assessment processes for referrals to Social Work /Occupational Therapy, using less qualified staff for simple SW/OT assessments Focus on re-enablement particularly for hospital discharge cases, leading to reduced packages of care in the medium term We recognised that we had to change and modernise the whole system of care and support services for older people in our area. This meant we replaced some residential care homes and created new Housing with Care units to give better choices for older people installed smart technology packages in the homes of 3000 older people in West Lothian trained and equipped staff to carry out a variety of tasks in their contact with older people concentrated our home care service on meeting personal care needs found new ways to provide meal preparation and shopping services enabled less qualified staff to deal with simple assessments of need, allowing Social Workers and Occupational Therapists to concentrate on complex cases tried to restore functionality to older people where possible to enhance their quality of life We recognised that we had to change and modernise the whole system of care and support services for older people in our area. This meant we replaced some residential care homes and created new Housing with Care units to give better choices for older people installed smart technology packages in the homes of 3000 older people in West Lothian trained and equipped staff to carry out a variety of tasks in their contact with older people concentrated our home care service on meeting personal care needs found new ways to provide meal preparation and shopping services enabled less qualified staff to deal with simple assessments of need, allowing Social Workers and Occupational Therapists to concentrate on complex cases tried to restore functionality to older people where possible to enhance their quality of life

5. Assistive Technology in West Lothian The pyramid represents the differing levels of technology our clients in the community have the base level the Home Safety service is the largest group with a “core package of technology” fitted to their own homes, there are about 2,400 clients in this group. The second level is where we have a core package plus additional equipment on an individual needs based assessment, this can be a variety of items- wandering devices, video door entry systems, chair or bed occupancy devices the list is fairly extensive. This group equates to 13% of our clients. 312 clients have the Home safety service + The final group are the tenants supported in our Housing with Care tenancies who have a core package of technology, a video door entry system and a pull emergency cord in the bathroom- this group can also access extra technology as there needs require it. We will always need Care Home beds and long term hospital beds but the aim is to keep people in their own homes in the community with support where possible. The pyramid represents the differing levels of technology our clients in the community have the base level the Home Safety service is the largest group with a “core package of technology” fitted to their own homes, there are about 2,400 clients in this group. The second level is where we have a core package plus additional equipment on an individual needs based assessment, this can be a variety of items- wandering devices, video door entry systems, chair or bed occupancy devices the list is fairly extensive. This group equates to 13% of our clients. 312 clients have the Home safety service + The final group are the tenants supported in our Housing with Care tenancies who have a core package of technology, a video door entry system and a pull emergency cord in the bathroom- this group can also access extra technology as there needs require it. We will always need Care Home beds and long term hospital beds but the aim is to keep people in their own homes in the community with support where possible.

6. Home Safety Service Home Alarm unit with two way speech Smoke Detector Extreme Temperature Sensor 2 x Flood Detectors 2 x Activity Detectors This slide describes the elements of technology that make up the core package used in West Lothian The equipment is all radio triggered so it is quick to install a core package can be installed in 30 minutes, and removed in less time when the client no longer requires it. The calls all go to a call centre that is staffed 24/7 with trained telecare operators The home alarm unit provides 2 way speech, and all the other sensors are triggered to this unit. It sends calls to the call centre based on a landline telephone system. Radio triggered smoke detector alarms locally but also at the call centre so any smoke/ fire is detected and acted upon even if the house is empty or the client could not call for emergency services by themselves. The extreme temperature sensor picks up both extremes- if someone is at risk of hypothermia and if the house has become too hot as a result of a flash fire or cooker has been left on . Two flood detectors are supplied one for the bathroom and one in the kitchen, the technology is such that the call centre can tell which of the two has alarmed, this makes the response to correct the problem quicker. The activity detectors are passive infra red sensors and are used to monitor activity and as a home security system. This slide describes the elements of technology that make up the core package used in West Lothian The equipment is all radio triggered so it is quick to install a core package can be installed in 30 minutes, and removed in less time when the client no longer requires it. The calls all go to a call centre that is staffed 24/7 with trained telecare operators The home alarm unit provides 2 way speech, and all the other sensors are triggered to this unit. It sends calls to the call centre based on a landline telephone system. Radio triggered smoke detector alarms locally but also at the call centre so any smoke/ fire is detected and acted upon even if the house is empty or the client could not call for emergency services by themselves. The extreme temperature sensor picks up both extremes- if someone is at risk of hypothermia and if the house has become too hot as a result of a flash fire or cooker has been left on . Two flood detectors are supplied one for the bathroom and one in the kitchen, the technology is such that the call centre can tell which of the two has alarmed, this makes the response to correct the problem quicker. The activity detectors are passive infra red sensors and are used to monitor activity and as a home security system.

7. Home Safety Service + Fall detector Chair/Bed Occupancy Detector Wandering Detector Incontinence Detector Automated Reminders Automated Control of Lighting/Windows/Door Video door entry Carbon monoxide detector Voice recognition On a needs based assessment the staff would look at ways other technology in addition to the core package could manage identified risk This list is only a selection of the additional sensors that are in the community in West Lothian The most common additions are fall detectors when a sensor is worn on the waist and it alarms if the wearer tips more than 45 degrees and/or it feels force in the case of falling to the ground. Wandering detectors, where a sensor is placed on the bed and usually a door contact on the door of the property have worked well Video door entry systems were anxiety is relieved by the client being able to see who is at the door and where appropriate open the door remotely On a needs based assessment the staff would look at ways other technology in addition to the core package could manage identified risk This list is only a selection of the additional sensors that are in the community in West Lothian The most common additions are fall detectors when a sensor is worn on the waist and it alarms if the wearer tips more than 45 degrees and/or it feels force in the case of falling to the ground. Wandering detectors, where a sensor is placed on the bed and usually a door contact on the door of the property have worked well Video door entry systems were anxiety is relieved by the client being able to see who is at the door and where appropriate open the door remotely

8. Housing with Care In Housing with Care we have used lifestyle monitoring to develop a base line of someone's normal behaviour and pattern. To do this in addition to the core package we add a passive infra red detector ( movement sensors) in every room, 2 electricity monitors where you can check which appliances are being used i.e. microwave,2 door contacts, usually on the main door to the property and the fridge and a chair and bed sensor. Assessment tool is a software package developed with your technology partners Tunstall Ltd. to carry out an assessment based on risk management and it will prescribe what technology may help in the situation Medication reminders use the Home alarm unit and can give clients a speech prompt to take medication a family members voice can be recorded to be more recognisable to the clients Epilepsy monitors have allowed particularly young people to move out of the family home and be managed in their own homes with the use of epilepsy monitors where before the risk was thought to be too great for them to live alone Plans to look at telemedicine to manage long term conditions ie Chronic Obstructive Pulmonary Disease, Diabetes, Chronic Heart Failure and Hypertension to avoid where possible multiple emergency hospital admissions.In Housing with Care we have used lifestyle monitoring to develop a base line of someone's normal behaviour and pattern. To do this in addition to the core package we add a passive infra red detector ( movement sensors) in every room, 2 electricity monitors where you can check which appliances are being used i.e. microwave,2 door contacts, usually on the main door to the property and the fridge and a chair and bed sensor. Assessment tool is a software package developed with your technology partners Tunstall Ltd. to carry out an assessment based on risk management and it will prescribe what technology may help in the situation Medication reminders use the Home alarm unit and can give clients a speech prompt to take medication a family members voice can be recorded to be more recognisable to the clients Epilepsy monitors have allowed particularly young people to move out of the family home and be managed in their own homes with the use of epilepsy monitors where before the risk was thought to be too great for them to live alone Plans to look at telemedicine to manage long term conditions ie Chronic Obstructive Pulmonary Disease, Diabetes, Chronic Heart Failure and Hypertension to avoid where possible multiple emergency hospital admissions.

9. Redesign outcomes Reduced numbers of those awaiting discharge from 67 in April 2000 to 3 in November 2006. Reduced length of average stay in care homes from 36 months to less than a year for recent admissions over the period Reduced waiting times and lists for Social Work and Occupational Therapy assessment and service delivery Maintained older people at home for as long as possible Enhanced staff skills, roles and job satisfaction Reduced packages of care for significant number of service users Rapid response function saving around 3,200 hospital bed nights per annum We have achieved some significant outcomes as a result of the changes we have made across the system. These include reducing the number of older people waiting to be discharged from hospital, and reduced the time they had to wait reduced the average length of stay in care homes, allowing older people to remain at home longer near the end of their lives reduced the time older people had to wait for an assessment to start, and for it to be completed improved staff skills and job satisfaction, and given them wider roles for some older people, reducing the scale of the package of care required to support them by restoring where possible some of their own functionality saving bednights in the local hospital by preventing admissions in the first placeWe have achieved some significant outcomes as a result of the changes we have made across the system. These include reducing the number of older people waiting to be discharged from hospital, and reduced the time they had to wait reduced the average length of stay in care homes, allowing older people to remain at home longer near the end of their lives reduced the time older people had to wait for an assessment to start, and for it to be completed improved staff skills and job satisfaction, and given them wider roles for some older people, reducing the scale of the package of care required to support them by restoring where possible some of their own functionality saving bednights in the local hospital by preventing admissions in the first place

10. Redesign outcomesDelayed Discharge 2000 - 2006 This graph merely shows the reduction in the number of older people waiting for discharge over time.This graph merely shows the reduction in the number of older people waiting for discharge over time.

11. What Have We Learned Over The Last 5 Years “Doing assistive technology” on its own without wider system improvements is a wasted opportunity Assistive technology is not a cut-price alternative to personal service but helps stretch the human element further Security possibilities of assistive technology are attractive to older people and their carers Upstream inputs like assistive technology impact in due course on downstream demand An approach driven by technology won’t work High level of commitment particularly at senior levels is required Careful approach and investment of time in taking staff, users and carers is required A focus on cost saving is counter-productive We have learned a number of important lessons over the time we have been re-engineering the care system for older people in West Lothian. Concentrating on smart technology without looking at whole system changes and improvements will provide little real benefit on its own using technology sits alongside the delivery of personal care services, but does not replace those personal services where needed older people, their families and their carers enjoy the added security they feel smart technology gives them the use of smart technology may defer the need for substantial care assistance in due course redesigning the care system requires back up and support from senior staff and officials it took time and effort to take staff, users and carers with us as we tried to make substantial changes in the system We have learned a number of important lessons over the time we have been re-engineering the care system for older people in West Lothian. Concentrating on smart technology without looking at whole system changes and improvements will provide little real benefit on its own using technology sits alongside the delivery of personal care services, but does not replace those personal services where needed older people, their families and their carers enjoy the added security they feel smart technology gives them the use of smart technology may defer the need for substantial care assistance in due course redesigning the care system requires back up and support from senior staff and officials it took time and effort to take staff, users and carers with us as we tried to make substantial changes in the system

12. Next Stage of Development Extension of telemedicine developments in-home health monitoring video-calls from Primary Care team to target groups mental health possibilities remote consultant consultations/diagnostics Wish to move to set top box delivering wider benefits to users Increase intelligence capability of houses Lifestyle monitoring in community houses Further mainstreaming of home-based technology The next stages of our development in West Lothian are likely to involve bringing in more telehealth/telemedicine features alongside our telecare measures looking to see whether we can move on from a community alarm unit base to a set-top box, integrating a wider variety of services into one telecare system exploring how we can make houses more “intelligent” in supporting and protecting their occupants extending our lifestyle monitoring technology into more community houses establishing the use of telecare technologies as a mainstream feature of housing and support for those who need it The next stages of our development in West Lothian are likely to involve bringing in more telehealth/telemedicine features alongside our telecare measures looking to see whether we can move on from a community alarm unit base to a set-top box, integrating a wider variety of services into one telecare system exploring how we can make houses more “intelligent” in supporting and protecting their occupants extending our lifestyle monitoring technology into more community houses establishing the use of telecare technologies as a mainstream feature of housing and support for those who need it