Telecare Project Review and Evaluation Report - Draft

Cardiff Council

Telecare Project Review and Evaluation Report

December 2009

1.Introduction

The Telecare Project in Cardiff commenced installations of telecare packages in March 2007 following award of the Telecare Capital Grant of £776,308 from the National Assembly for Wales under the Local Government Act 2003, Section 31.

The project aimed to improve the health, safety and well-being of Cardiff’s most vulnerable citizens by providing telecare packages that could support and maintain independence, self-esteem and dignity for the user and provide family and carers with greater reassurance and peace of mind.

Expectations were that the project would:

• contribute to the reduction in Delayed Transfers of Care (DTOC)
• support people with cognitive impairment to remain as independent as possible for as long as possible
• improve the response to people who are at risk of falling
• provide support to carers, particularly those who are elderly

Priority user groups for referral to the telecare project were identified from the Health, Social Care and Well Being Strategy. Cardiff’s Older Persons Strategy and Commissioning Strategy also informed the choice of priority groups. Chosen priority groups were:

• hospital discharge
• prevention of falls
• cognitive impairment (including older people, people with learning disabilities)
• support for carers 75+

Cardiff County Council aimed through the telecare project to provide at least 880 homes with sensors and equipment as part of the contribution to the National Assembly for Wales target of 10,000 homes equipped throughout Wales.

(Source: Cardiff County Council – Telecare Strategy 2006-2008. Cardiff County Council, 2006)

Telecare project review and evaluation report

This report seeks to provide a review and evaluation of the telecare project in Cardiff. Initially, the report will review details of the referrals made to the telecare project as well as review details of the telecare packages installed. Following on from this the report will analyse the results of the client telecare questionnaire and the telecare survey that was undertaken to explore the views of service users and their families / carers. The report will then review details of telecare alerts and their responses. Finally, the report will seek to evaluate the telecare project by examining evidence of case studies, internal and external reviews and evaluations undertaken of pilot or mainstream telecare services from around the UK and the outcomes obtained in Cardiff.

2.Referrals to the Telecare Project

Referrals to the telecare project commenced in March 2007 and ranged from basic ‘home safety’ telecare packages to more complex ‘bespoke telecare packages.

Referrals for bespoke telecare packages

Between March 2007 and the 30th November 2009, the telecare project received 830 referrals for ‘bespoke’ telecare packages from Case Managers within Adult Services. These referrals were made to the telecare project following the Unified Assessment Process which identified the need for a package of telecare to address identified risks to clients such as falling, purposeless walking from home, flooding in bathrooms or kitchens, nocturnal enuresis problems, leaving the gas on, fire/smoke, epileptic seizures, etc.

Referrals for ‘bespoke’ telecare packages to the telecare project from Case Managers within Adult Services can be broken down by Adult Service Team as follows:

Referrals for bespoke telecare packages incorporated requests for a variety of telecare detectors and sensors, including:

• lifeline
• pendent
• bed occupancy sensor
• chair occupancy sensor
• enuresis sensor
• epilepsy sensor
• fall detector
• gas detector
• gas shut off valve
• medication dispenser
• pillow alert
• passive infra red detector
• property exit / entrance sensor
• pressure mat
• DDA pager solution
• universal sensor
• X10 lamp module controller
• mobilalarm
• big button phone
• video door entry system
• door entry system
• environmental control unit
• smoke detector
• carbon monoxide detector
• temperature extreme sensor
• bogus caller button
• flood detector
• keysafe

Referrals for ‘bespoke’ telecare packages to the telecare project were sent to the Community Alarm Service by Case Managers within Adult Services for registration on the PNC5 response database. Following registration and the assignment of a unique ID number, these referrals were then forwarded to Care & Repair Cardiff by the Community Alarm Service to arrange installation.

Referrals for basic home safety telecare packages

Between October 2007 and the 31st March 2009, the telecare project also received 328 referrals from the Community Alarm Service for basic ‘home safety’ telecare packages. These referrals were for existing Community Alarm Service users who were also receiving a package of care from Adult Services.

Referrals for basic home safety telecare packages included some or all of the following equipment:

• lifeline
• pendent
• smoke detector
• carbon monoxide detector
• temperature extreme sensor
• bogus caller button
• flood detector
• keysafe

Following identification of suitable clients, referrals for ‘home safety’ telecare packages were sent to Care & Repair Cardiff by the Community Alarm Service to arrange installation. 255 of these Home Safety Packages have been installed in Cardiff.

3.Telecare Installations

The Telecare Project in Cardiff commenced installations of telecare packages in March 2007. Care & Repair Cardiff is responsible for installing the majority of telecare equipment with Tunstall and other suitably qualified contractors responsible for installing more specialist equipment (e.g. video door entry systems, gas detectors, and gas shut off solutions)

Between the 19th March 2007 and the 30th November 2009, 976 telecare packages were installed in Cardiff. Of these installations, 629 were ‘bespoke’ telecare packages and 255 were ‘home safety’ packages. The balance of 92 were installed by the manufacturer.

Details of number of installations are as follows:

126 referrals received for bespoke telecare packages were not progressed for installation. Reasons for not progressing these installations included client deceased, client did not return from hospital, client moved to residential/nursing care, equipment not wanted or equipment not suitable.

36 referrals received for basic home safety telecare packages were not progressed for installation. Reasons for not progressing these installations included client died, client did not return from hospital, client moved to residential/nursing care or equipment not suitable.

The types of telecare sensors installed and numbers are as follows:

In total, over 5,708 items of telecare equipment have been installed in Cardiff between the 19th March 2007 and the 30th November 2009.

Initially, some of the telecare equipment installed, was not wholly successful. For example, the early type of medication dispensers were not appropriate for use and had to be removed. Similarly, the early type of bed occupancy sensor were often found too sensitive. Other challenges reported include fall detectors not activating, gas detectors not activating and epilepsy sensors inappropriately activating. Many of these issues have been resolved by working with the manufacturers. For example, newer types of medication dispensers and replacement gas detectors are now installed. Additionally, some sensors can now have their sensitivity adjusted remotely from the monitoring centre using PNC5.

It is anticipated that 1,000 installations will have been completed by the end of December 2009. This exceeds the anticipated 880 installation target as outlined in the telecare strategy, and represents a significant achievement by the telecare project in implementing a new service.

4.Client Telecare Questionnaire

Following installation of the telecare package, clients were sent a questionnaire form by Care & Repair Cardiff to complete and return (with a SAE enclosed for ease of response). This questionnaire consists of several quantitative and qualitative questions and seeks to provide client feedback on:

• Satisfaction with the telecare installation
• Has the telecare package made it easier for the client to remain in their own home
• If the telecare package had not been installed, would the client have had to leave their home because they could no longer manage
• Would the client recommend the service to others
• Any other suggestions or comments the client wishes to make about the telecare service received

A copy of the questionnaire is contained in Appendix 1.

Between the 1st April 2007 and the 31st December 2008, Care & Repair Cardiff issued 565 telecare questionnaire forms to clients. As at 9th January 2009, the Agency had received 268 responses, a response rate of some 47.4%.

Question 1 - Satisfaction with the telecare installation

Question 1 sought views from clients regarding their satisfaction with the telecare installation.

210 clients were very satisfied with the telecare installation process (78.4%) and 56 clients were satisfied (20.9%).

2 clients were very dissatisfied with the telecare installation process (0.7%) because of problems with the medication sensor not working (medication sensor was removed) and the telephone being reinstalled in the wrong position (Agency went back and reinstalled phone to original position).

In respect of client comments regarding the telecare installation, 121 clients commented in this section of the questionnaire (45.1%). Many clients commented positively on the service they received from the Agency’s Handypersons who installed the package. For example:

‘A very polite and courteous engineer, respectful to the elderly and efficient in his job’

‘All your contractors responded very quickly to my mother's needs and we were very impressed by the careful installation and courtesy of all involved. Thank You’

‘Excellent service. Friendly & helpful gentleman undertook the installation’

‘Gentleman who installed the equipment was extremely pleasant, helpful & patient. I would highly recommend him to anyone’

‘Quickly and professionally installed - excellent job’

‘The man who did the installation was very efficient and explained everything very clearly which made it all easy to understand’

‘Very polite young man explained very clearly as he went along with the work’

Some clients also commented in this section on the benefits they perceived from the telecare package installation, particularly in respect of improved independence and safety. For example:

‘The Telecare installation has made me feel much safer in my own home’

‘I am very grateful for all the Telecare equipment put in to help me to stay in my home by myself’

‘The Telecare installation work that was completed in my home has made me feel more safe. I am very pleased with the work which was done’

Full details of all the client comments regarding the telecare installation are contained in Appendix 2.

Question 2 – Any complaint with the installation service

Question 2 sought views from clients regarding any dissatisfaction or complaint they may have with the installation service and whether they would like to take this further.

No clients responded that they would like complain or receive a copy of the Agency’s complaints procedure to take the matter further.

Question 3 – Has the telecare package made it easier for the client to remain in their own home

Question 3 sought views from clients regarding whether the telecare package has made it easier for them to remain in their own home.

Overall, 249 clients felt that the telecare package had made it easier for them to remain in their own home (92.9%).

6 clients felt that the telecare package did not make it any easier for them to remain in their own home (2.2%).

11 clients did not answer this question (4.1%)

Question 4 – If the telecare package had not been installed, would the client have had to leave their home because they could no longer manage

Question 4 sought views from clients regarding whether if the telecare package had not been installed, would the client have had to leave their home because they could no longer manage.

Overall, 24 clients felt that they definitely would have had to leave their home because they could no longer manage if the telecare package had not been installed (9.0%), whilst a further 75 clients felt it was likely that they would have had to move (28.0%).

99 clients felt it was unlikely they would have had to leave their home because they could no longer manage if the telecare package had not been installed (36.9%), whilst a further 45 clients definitely felt they would not have had to move (16.8%).

25 clients did not answer this question (9.3%).

Question 5 – Would the client recommend the service to others

Question 5 sought views from clients regarding whether they would recommend the service to others.

Overall, 255 clients said they would recommend the service to others (95.1%).

5 clients stated that they would not recommend the service (1.9%).

8 clients did not answer this question (3.0%).

Question 6 – Any suggestions to improve service or comments the client wishes to make about the telecare service received

Question 6 sought views from clients regarding improving the service or any other comments clients wished to make about the telecare service received.

88 clients commented in this section of the questionnaire (32.8%). Several clients commented positively on the benefits they perceived from the telecare package installation, particularly in respect of improved independence and safety. For example:

‘I am completing this form on behalf of my husband who has Alzheimer’s and I feel so much safer with the smoke and water detectors and particularly the gas detectors. The button on the back of the front door is reassuring as is the keysafe’

‘. . . I feel much more confident now with the extra help I shall have more quickly when anything happens. My daughter called in before he (the Handyperson installer) left so she had some information about it all and was very impressed with all of it’

‘Nancy has Alzheimer’s and would not be able to live alone. The additional monitors fitted are primarily for when we are away on holiday and she will be alone between care visits’

‘. . . the equipment is to help me look after my disabled daughter . . . thanks for the equipment as I can now get a good night's sleep’

Some clients commented that they would have liked to have had easy to understand guidelines, instructions or literature on how the telecare sensors and equipment installed worked and what would happened if they go off. For example:

‘I would like to have been left literature about the things installed - i.e. guidance on how it works and what would happen in the event of a flood - as I have memory problems and then could look back over it’

‘Clear guidelines on how to use each piece of equipment - e.g. epilepsy sensor, PIR sensor, especially how to turn it on and off’

‘Simple written instructions for each piece of equipment would help my mother to remember how the alarms will operate and make her less nervous about what to expect if the alarm sounds’

Some clients commented on their concerns regarding the equipment installed, particularly the keysafes

‘I am nervous of leaving keys in the keysafe’

‘Very worried about the keysafe outside, possible target for vandalism in the area, will be looking to get an electronic door entry system’

Full details of all the views from clients regarding improving the service or any other comments clients made about the telecare service are contained in Appendix 3.

Question 7 – Further help or advice

Question 7 sought views from clients regarding any further help or advice they may need.

Overall, 11 clients requested further help or advice (4.1%) on matters ranging from changing the location of telecare sensors, removing equipment not wanted as well as other issues such as repairing a light or hanging up curtains. In each instance, the Agency contacted the client and provided a response to their request.

Client Telecare Questionnaire - Conclusion