Community equipment and housing adaptations: draft guidance

Technology enabled Health & Care

Digital technology is the area of greatest change in society, and of potential transformation for health and social care.

Scotland's Digital Health and Care Strategy, April 2018

Technology Enabled Care (TEC) is defined as "where outcomes for individuals in home or community settings are improved through the application of technology as an integral part of quality, cost effective care and support". Included under the definition of TEC, are community alarm and telecare services.

According to a feasibility study, in Scotland around 20% of people aged over 75 are in receipt of a community alarm/telecare service. Services can be provided by Health and Social Care Partnerships (HSCPs), housing providers or independent providers. The majority of people in receipt of telecare (around 137,000 people) receive their service from their HSCP. Almost all HSCPs charge for their service – between £1.40 and £8.50 per week.

Telecare services support people to live safely at home with greater confidence, independence and freedom – often preventing or delaying admissions to care homes and hospitals, as well as supporting people on discharge from hospital. The service provides the person, their unpaid carers, and families, with peace of mind and assurance of a rapid response should an incident occur.

A community alarm is a form of equipment, linked to the home telephone, for communication, especially useful as an alert should the user have an incident where they require to call for help quickly. Typically, it includes a button/pull cord/pendant. It can be used within an individual's own home or part of a communal system.

Telecare refers to a technology enabled care package which goes over and above the basic community alarm. It usually refers to sensors or alerts which provide continuous, automatic and remote monitoring of care needs, emergencies and lifestyle. Examples include smoke, heat, gas and flood detectors, fall detectors, door exit sensors, epilepsy and enuresis sensors and GPS locator trackers. Telecare will usually, but not always be 'linked' to the home hub or communal alarm system.

Both community alarms and telecare transfer alerts, alarms or data to a call handler in a 24/7 monitoring centre or an individual responder, such as a carer or family member. Many HSCP telecare services also offer a telecare responder service, which provides an in-person response to an alert, when required. For services that don't have this option, the call handler can contact a responder, identified by the person receiving the service. Emergency services will always be contacted when required.

An additional offering of most telecare services is Lifestyle Monitoring. Lifestyle Monitoring is a digital activity monitoring system that can help care professionals complete objective and evidence-based assessments, enabling people to receive the right level of care and support. It involves installing discreet door and movement sensors around a person's home for a limited assessment period, providing an overview of their daily activity, and helping professionals make proportionate care decisions.

A telecare self-check online tool is available on NHS inform, which enables people to find information about telecare services in their area.

Telecare services are entering a significant period of change - over the next few years they will transition from an analogue to a digital service. The transition will be a major piece of work, however, it will bring opportunities to redesign and innovate, and achieve better outcomes for people who receive the service. Ambitions for telecare include adopting a more integrated, proactive and intelligence-informed approach to care and support, which embraces smart sensor technology and consumer devices.

Scotland's Digital Health and Care Strategy outlines how technology will be used to reshape and improve services, support person-centered care, and improve outcomes. The Strategy will be refreshed in 2021.

The vision going forward is of a better, integrated approach. Technology plays an important role in supporting prevention, early intervention, and self-management, and many community services have started to explore consumer pathways, providing options for people to choose their own digital solutions as part of self-management and earlier intervention strategies.

There are also excellent examples from Housing providers which illustrate how important this type of technology can be, in preventing isolation and enabling people to better manage all aspects of their lives.

The TECHousing website provides examples of initiatives already in place which have been invaluable during the Covid pandemic, making a significant contribution to helping people feel less isolated and more connected and assisting them to access services far more easily. These approaches are also promoting the use of preventative analytics to allow greater opportunity for intervention at an earlier stage, potentially reducing the risk of falls and frailty. There is considerable opportunity for Housing and Health and Social Care partners to work together to maximise the opportunities these approaches offer.

In the context of the review of Adult Social care, and the proposals for a national Care Service, the provision of technology is acknowledged as an important mechanism to support the shift to more preventative services. A feasibility study for the provision of telecare services for over 75s, published in August 2017, explored the potential for universal Telecare services, as a way of helping achieve these aims. The report identified ways in which uptake of services could be improved and charging was identified as one of the barriers. Recommendations from that report included the need to standardise approaches across the country, increase equity, and full exploration of ways to reduce costs in the system and in turn, reduce cost to the service user, as a barrier to provision. Overall strategy needs to be aligned with wider health and social care service objectives, in order to help maximise the potential of these services, to keep people safe and well in their own homes, preventing cost elsewhere in the health and social care system.

For more information on the Scottish Government's TEC Programme and telecare, please go to TECScotland.

Key Actions

• Health and Social Care partners, with their Housing colleagues, should work together to maximise the opportunities provided by TEC, developing local strategy and policies, which help people to choose their own digital solutions as part of self-management and earlier intervention approaches, as well as utilising technology to address issues of isolation and frailty. This should include reviewing charging policies to ensure that these are not acting as a barrier in the system, preventing services from supporting those most vulnerable.