BridgeLink Telecare

Performance Report

September 2008 / March 2010

and direction of the future service

BridgeLink Telecare : Performance Evaluation September 2008 to March 2010 and future service direction

  1. Purpose of the report

The purpose of this report is to evaluate of the performance of the BridgeLInk Telecare service over the first 18 months of operation from September 2008 to March 2010, to seek where possible to identify whole system savings, and to make recommendations about the future of the service.

The challenge that telecare offers is the prospect of preventative care services that allow vulnerable people in the community independence at lower overall service cost, whilst acknowledging that these outcomes are dependent on the sensitive design of service provision for specific users and of ensuring that the service is sustainable.

2.Policydrivers

Telecare addresses a number of different policy agendas dating back at least a decade. Some of these relate to helping people live independently and safely at home, others to the reform of health service delivery. More recent policy documents that have specifically focussed upon telecare include:

  • The Review of Health and Social Care 2003
  • A Strategy for Social Services in Wales over the next decade: Fulfilled Lives, Supportive Communities 2006.
  • Designed for Life 2005 The National Strategy for Older People in Wales 2003, the NSF for Older People in Wales 2006 and One Wales: A Progressive Agenda for the Government of Wales 2008
  1. Local context

The provision of a new integrated BridgeLink telecare service that is available for people to access 24/7 as and when they require it has been successfully managed within the Adult Social Care programme:Supporting Independence at Home Programme. The focus of this programme is to develop new services and realign existing services to provide high quality person centred care.

The development of telecare service has also been guided by the Bridgend Telecare Strategy 2008 -2011. This was developed by a multi agency Project Board. The further development of telecare and the implementation of telehealth services is the ongoing focus of the Strategy.

Telecare in Bridgend is now a mainstream service. It is managed as part of the joint multi - disciplinary Community Integrated Intermediate Care Service (CIIS) which will also provide a sound platform for the associated development of telehealth. The mobile response team, which is a key part of the telecare development, also supports the work of the CIIS nurses by responding to unscheduled care needs to prevent unnecessary hospital admission.

The implementation of the Telecare Strategy is reported to the Joint Management Board for Intermediate Care.

  1. Partnership Working

The BridgeLInk Telecare service was introduced in 2008. The plan was to introduce Telecare technology initially by targeting the service users of BridgeStart Home Care service and the Intermediate Care service because they were recently discharged from hospital, in need of a significant level of support, and therefore on the cusp of requiring further health and social care services.

It was agreed at the outset that telecare equipment would be assessed by the OTs as part of a specialist assessment. Referrals from the community would come via the First Contact Team and the social workers and Health OTs would have a fast track referral/assessment process to facilitate hospital discharge. Training for all relevant staff has been conducted by the Telecare Co-ordinator.

The Council works with a number of other partners to deliver and support telecare. These include Bridgend County Care and Repair, Merthyr Borough Council, Linc Cymru and the Bridgend Carers Centre.

  1. Funding

Capital Funding

The WAG Telecare Capital Grant opened up the way for the innovative use of telecare provision in the Borough from 2008. In total, £8.92m of Telecare Capital Grant funding was allocated throughout Wales. Bridgend received an allocation from this Grant of £376,091 to be spent by 31stMarch 2009. The Grant was designed to improve outcomes for people and assist the modernisation of services. It was therefore be used to provide new services to new people and to add value to existing services.

Revenue Funding

In addition a further WAG Revenue Grant of £40,000 was received for the development and management of the service. Subsequently, additional WAG Grant from both the Promoting Independence and Wellbeing Grant and the Continuing Health Care Grant funding has been used to develop the service further.

  1. Management and Staffing

The service has been managed within the CIIS service since February 2010. Previously it was managed within the Council’s Community OT team and Home Care.

The present staff structure of the service is:

  • A 0.7 FTE telecare co-ordinator responsible for the day to day operation of the service, and providing advice, assistance and training to staff, service users and their carers.
  • A mobile response FT team leader
  • 12 0.4 FTE (plus out of hours standby and call out payments)mobile response workers operating on a 24 hour/7 day rota. This team also provides support for the CIIS nurses in meeting urgent care needs between 8.00 am and 8.00 pm.

In addition, the Council commissions Bridgend County Care and Repair to provide an installation, maintenance, repair and removal service. This is undertaken within Care and Repair by a FT Handyperson and a FT Administrative Assistant.

  1. What is Telecare

Telecare is a remote or enhanced delivery of services to people in their own home by means of telecommunications and computerised systems. It monitors various types of risk in people’s homes and provides additional support with specific needs using wireless enabled equipment designed for this purpose. Telecare sensors are linked via a community alarm (lifeline) to a 24/7 monitoring service. In Bridgend, the monitoring centre can call upon the 24/7 BridgeLink mobile response team when required.

  1. Outcomes required

The telecare service aims to improve the confidence dignity and independence of service users as a result of increased security and the reassurance that there is support available if needed.For carers; the service seeks to improve their confidence within the caring role and to offer re-assurance that there can be rapid contact if there is a problem.The main outcomes required of the service are therefore to:

Provide reassurance and support the confidence of service users and their carers

 Give users greater control of their own lives by reminding them of tasks that they wish to complete or providing information about developing risks

Identify changes in the personal circumstances of the user and enable an immediate and appropriate response

Support professionals in making risk and care assessments

Enable care professionals to shorten the time period between the occurrence of an event and the delivery of the appropriate care interventions

Provide effective support for carers alongside traditional healthcare, social care and housing initiatives.

  1. Overview of outcomes
  • Telecare training programme delivered by Telecare Services to over 350front line health and social care professionals.
  • There were 504 service users at end March 2010. Since the first installation the service has installed 673 Telecare packages and has169 withdrawals
  • 390 Telecare activations have resulted in mobile response staff attending client’s homes.
  • This included 152 falls (38%) which activated Telecare sensors and resulted in staff attending clients who had fallen and were on the floor
  • 75% of all mobile response service calls were attended within the 30 minute performance indicator. Of the remaining 25% the average response time was 47 minutes.
  • The average time from referral to installation of Telecare by Bridgend County Care and Repair was 4 days for urgent installations (target: 5 days) and 8 days for non urgent installations (target: 15 days)
  1. Use of telecare in Bridgend

Number and sources of referrals

Number / % of OT Referrals
BridgeStart OTs / 109 / 20%
Community OTs / 334 / 60%
Health OTs (Reablement/CIIS) / 26 / 5%
Health OTs (Acute Care/CMHT) / 83 / 15%

The difference between the number of referrals above and the overall number of referrals is as a result of pro active targeting of users by Care and Repair.

There has been a significant increase in number of referrals from Health OTs in the period from January 2010 as a result of a OT project that investigated the barriers to referral and provided subsequent training and system improvements.

Reasons of referral

Number / % of Referrals
Cognitive impairment / 47 / 9%
Falls / 335 / 60%
Functional mental illness / 8 / 1%
Reducing anxiety / 83 / 15%
Epilepsy / 26 / 5%
Other Reasons* / 53 / 10%

* The other reasons category covers installations that do not fit directly into one of the above categories and includes people with chronic conditions, sensory impairment, relieve carer stress, safety at home and medication prompts.

Age of service users

The following data shows the age of the active Telecare clients at the end of March 2010 but does not include the Telecare installations within Supported Living Schemes.

Live alone / 42%

Service users FRAT questionnaire responses (322 people)

66% had a fall within the last 12 months

76% had 4+ medications

70% of results indicated the need for a falls assessment, of these 30% of the individuals concerned were 85+, and 49% 80 plus.

Take up of telecare and timeliness of the installations

The following table shows the amount of Telecare equipment installations carried out with time taken to install equipment from Bridgend County Care and Repair receiving referral to installation and reasons if over the 5 day and 15 day performance indicators for urgent and non urgent installations.

Referrals / No.
Referrals / No. installs. / No.
Disconnect. / Av.Time referral to install.
Urgent / No.
Referrals over target 5 days / Av.Time referral to install.
Non Urgent / No.
Referrals over target 15 days
Sept.-Dec 2008 / 171 / 80 / 1 / - / - / - / -
Jan. – March
2009 / 237 / 106 / 8 / 6 / 3 / 11 / 2
April – June
2009 / 81 / 88 / 18 / 3 / 0 / 7 / 4
July – Sept
2009 / 138 / 108 / 28 / 4 / 0 / 10 / 19
Oct- Dec
2009 / 132 / 115 / 24 / 5 / 1 / 8.5 / 14
Jan – March
2010 / 154 / 130 / 35 / 4 / 1 / 12 / 30
Total/
averages / 913 / 625 / 116 / 3.6 days / 5 / 8 days / 69

Bridgend County Care and Repair have a 5 working days performance indicator to install equipment from receiving an urgent referral and 15 days for a non urgent referral. This indicator was put into place in January 2009. Bridgend County Care and Repair has met this performance indicator on 551 occasions (88%) , failing to reach this target 74 times (12%) in the period. The reasons for these delays were mainly family issues and the timeliness and availability of stock delivery from Vision Products .

The quantity, type and cost of Telecare Equipment installed

The chart below shows the type, amount & cost of Telecare equipment installed.

Install Dates / Sept- Dec 08 / Jan-Mar 09 / Apr- Jun 09 / Jul - Spet 09 / Oct-Dec 09 / Jan-Mar 10 / Total Issued / Total cost per item / Total Cost
Life Line 400 / 75 / 40 / 49 / 11 / 175 / £ 139.00 / £ 24,325.00
Lifeline Connect / 2 / 63 / 86 / 52 / 114 / 111 / 428 / £ 220.00 / £ 94,160.00
RAT + 4000 / 1 / 1 / 0 / 0 / 0 / 0 / 2 / £ 325.00 / £ 650.00
Gem / 0 / 1 / 4 / 3 / 0 / 1 / 9 / £ 39.77 / £ 357.93
Smoke / 121 / 103 / 81 / 115 / 147 / 140 / 707 / £ 40.80 / £ 28,845.60
Flood / 127 / 70 / 47 / 61 / 71 / 29 / 405 / £ 68.00 / £ 27,540.00
CO / 94 / 69 / 55 / 88 / 97 / 89 / 492 / £ 80.75 / £ 39,729.00
Phone / 15 / 14 / 3 / 2 / 0 / 0 / 34 / £ 13.99 / £ 475.66
Bogus / 20 / 35 / 26 / 41 / 58 / 43 / 223 / £ 39.77 / £ 8,868.71
Fall / 3 / 18 / 33 / 36 / 44 / 53 / 187 / £ 75.00 / £ 14,025.00
Keysafe / 4 / 8 / 34 / 60 / 82 / 83 / 271 / £ 48.72 / £ 13,203.12
Temp Ext / 0 / 3 / 8 / 14 / 19 / 27 / 71 / £ 55.25 / £ 3,922.75
Bed/Chair Unit / 0 / 8 / 14 / 16 / 10 / 15 / 63 / £ 92.00 / £ 5,796.00
Bed pad / 0 / 8 / 14 / 16 / 10 / 15 / 63 / £ 35.00 / £ 2,205.00
Chair pad / 0 / 2 / 0 / 0 / 0 / 0 / 2 / £ 78.00 / £ 156.00
Epilepsy / 1 / 4 / 4 / 4 / 1 / 1 / 15 / £ 280.00 / £ 4,200.00
Medi dispenser / 1 / 3 / 7 / 7 / 5 / 4 / 27 / £ 150.00 / £ 4,050.00
Minute Watch / 1 / 1 / 4 / 10 / 11 / 20 / 47 / £ 65.00 / £ 3,055.00
Natural Gas / 0 / 5 / 4 / 12 / 7 / 15 / 43 / £ 108.00 / £ 4,644.00
Universal / 0 / 3 / 3 / 9 / 8 / 6 / 29 / £ 100.00 / £ 2,900.00
Prop Exit / 1 / 5 / 4 / 3 / 3 / 9 / 25 / £ 220.00 / £ 5,500.00
DDA Pager / 1 / 6 / 3 / 3 / 2 / 10 / 25 / £ 118.00 / £ 2,950.00
PIR / 0 / 0 / 2 / 0 / 0 / 0 / 2 / £ 36.00 / £ 72.00
Gas Shut Off / 0 / 0 / 1 / 0 / 1 / 0 / 2 / £ 400.00 / £ 800.00
Pull Cord / 0 / 1 / 0 / 0 / 4 / 5 / £ 51.00 / £ 255.00
ROM / 0 / 0 / 1 / 0 / 11 / 12 / £ 56.00 / £ 672.00
Pressure Pad / 0 / 0 / 0 / 1 / 1 / 2 / £ 8.43 / £ 16.86
totals / 467 / 471 / 437 / 602 / 691 / 698 / 3366 / £ 293,374.63

The needs of individuals for telecare are separately assessed. Therefore there are no standard packages, and increasingly equipment is being used more creatively to meet a range of needs.

The total cost of equipment is for new equipment, based on actual cost for each piece of equipment at the time of the most recent purchase. The total cost of stock installed in individual homes between September 2008 and March 2010 was £293,374. (This does notinclude equipment installed in supported living environments).This is not a true figure for cost of stock for the period covered however as towards the end of the period some existing stock was being recycled. More work is being undertaken to assess the impact of this.

The table shows that if all new equipment was provided to the 625 installation undertaken in the period until end of March 2010 the average new equipment cost per installation would be £435.

The table indicates that the telecare service installed 3366 separate pieces of equipment into client’s homes. Of these, 605 were lifeline units, which is the main speech unit for the telecare system. Of the sensors, environmental sensors were the most common sensors fitted. Sensors for detecting falls were the next highest followed by the equipment for memory loss issues with the numbers used reflecting the numbers of referrals received for each category.

Reasons for the disconnection of Telecare

During the timescales of this report telecare services disconnected 116 telecare packages

The reason for these disconnections were:

33% Service users went into Residential Care / Nursing Homes directly or via hospital.

41% Service users passed away.

4% Service users moved in with family.

Length of time the telecare service required

The average time that the person had had a telecare package before withdrawing was:

  • Moving into nursing care/going into hospital and unable to return - 6 months
  • Moving into residential care - 5 months
  • Service user passed away – 4 months
  • Service user not longer required/wanted telecare – 3 months

Response Team Activity July 2009 to March 2010

The number of calls to the monitoring Centre resulting in a mobile response team home visit as a direct result of Telecare Sensors

This graph shows the main sensors that are triggering call outs are reflecting what would be expected when the main category of installations are for people who have falls history. It also includes the number of people who have fallen and found by home care workers, and the number of times the ambulance is called by the team to assist.

Number, type and outcome of the calls responded to by the mobile response team

Call Out Data July 09– March 10

Reason / Action / Response within 30 mins / Over 30 Mins / Reason over 30 mins
Pendant / Connect box
180 / Unable to contact service user / 54 / Lifted / 78 / 164 / 16 / 1On another urgent call
8callout & travel time at night
2arranging assistance from home care
5 unable to locate property
Fallen / 104 / Equipment Power check / 13
Fault detected / 13 / Ambulance
Called / 18
Activation / 9 / Personal Care only / 25
P/C after getting up unaided after a fall / 4
Reassurance / 19
False alarm / 15
Family lifted prior to arrival / 8
Bed Sensor
12 / Unable to contact service user / 4 / Lifted / 3 / 9 / 3 / 2 callout & travel time at night
1 unable to contact family
Fallen / 4 / Client got up unaided / 1
Fault detected / 2 / Reassurance / 5
Client anxious / 2 / False alarm / 3
Environmental sensors
18 / Activation / 17 / Em Services Called / 7 / 11 / 7 / 1Unable to locate property
3attended after Em services
3 urgent response not needed
Other / 1 / MRT attended after Transco / 7
Reassurance / 4
Fall Detector
25 / Client Fallen / 4 / Lifted / 4 / 23 / 2 / 2 on another urgent call
Activation / 5
Unable to contact / 16 / False alarm / 21
Other / 1 / Police called / 1
Flood Detector
12 / Unable to contact / 3 / Cleaned Up - OK / 6 / 10 / 2 / 1 unable to locate property
1 on another T/C call
Activation / 9 / Referred to C&R / 1
False alarm / 5
Falls notified by Homecare/Out of hours service
46 / Fallen / 41 / Lifted / 29 / 41 / 5 / 4 on ERS call
1 on another T/C call
Reassurance / 5
Other / 5 / Family lifted
Ambulance called / 6
6
Meds dispenser
19 / Client anxiety / 1 / Reassurance / 4 / 14 / 5 / 5 Non urgent
Unable to contact / 9 / False alarm / 6
Activation / 9 / Equipment check / 4
Prompt meds / 5
Falls where MRT did not lift 46 / Ambulance called / 24
Admitted to hospital after ambulance attended / 3
Lifted by family/carers / 14
Got up themselves / 5

Please note: There are 41 activations not recorded due to Response Team being notified but attendance not needed. A further 37 call outs were not clearly recorded .

Examples of mobile response team responses due to telecare activations

Bed Sensor Example

A 92 year old female client referred due to a history of falls. This client’s bed sensor activated at 11.18pm stating she was out of bed. Staff arrived at the property within 30 minutes and found the lady on the floor in the bathroom. The lady was obviously in a great deal of discomfort and was later found to have fractured her leg in the fall. Staff arranged for ambulance contacted her family and made her as comfortable as they could. The key fact here is that without the telecare sensor being fitted to the property this lady had no way of contacting anybody and would have been laid on the floor for approximately 10 hours until her carer was due to arrive.

Fall Detector Example

Response team attended a 34 year old male who has multiple sclerosis, does not have the dexterity to press a pendant and is wheelchair bound. This gentleman was fitted with a fall detector on the tray of his wheelchair which he could knock onto the floor to alert the centre if he needed any help. He was particularly at risk during the day as his wife worked and he was on his own for long periods. Staff received a call from the fall detector at the property at just after 2pm and arrived onsite within 30 minutes to find that the client had fallen out of his chair and was on the floor. Staff hoisted him back into his chair and made him comfortable; he was not injured and did not require any further medical assistance following the fall. The key fact again here is that this client would have been laid on the floor for around 4 hours until his wife returned home from work without the installation of the telecare equipment.