It's well reported the population is ageing, a demographic change that is placing real pressure on our care system. What care is required, what's the best way to provide it, and how do we afford it?
The over 65s, however, are not a homogenous group and so there are no easy answers to these questions. Care needs are almost certainly varied and complex depending on an individual's physical and mental capabilities. Even within the sphere of one illness, dementia, the spectrum of needs is varied, depends on other conditions, and changes over time. Older people in the early stages of dementia may be very capable, while in the later stages, or if combined with another debilitating illness, they may be very restricted.
Today there are about 800,000 people in the UK living with dementia and by 2020 that number is expected to reach 940,000. Two-thirds of these people live at home, many with the daily support of homecare services. Already this is almost financially unsustainable, and the stress on budgets will grow as we head towards 2020 and beyond.
We need to innovate and develop new solutions, which is where technology could be key. People living with dementia often find it difficult to clearly communicate their needs, making it hard for professionals to understand the support required. Without being intrusive or invading someone's privacy, activity monitoring systems can help those involved in someone's care better understand how they are coping in their own home. Small wireless sensors placed around the main rooms of the home record movements and display them on a secure online chart. Professionals and family members can view the charts to see, for example, if someone is getting up a lot in the night, going into the kitchen at times they might be expected to prepare meals, or is going outside at unusual times. This information builds up a 'picture' of how someone is managing day to day, whether or not they can cope alone in their home and what sort of care package would benefit them most. In effect it gives the person with dementia a voice in the decision making process. Application of this technology frequently means that people who would otherwise be moved to a residential home can stay in their own home, a happier outcome for the individual and their family, and far cheaper for tax payers.
By giving objective, evidence-based insight into an individual's needs, this type of technology is both improving the quality of care and saving money. A study conducted by Staffordshire county council and published by the Department of Health, looked at 21 cases where it was thought admittance to residential care was required. Following assessment using Just Checking, 13 of these people were able to stay at home for longer than expected. The assessments highlighted where care support could be used to best effect, as well as the scope for using other technology to manage the situation. For example, it was thought that Margot, a 71-year-old woman with dementia living alone, needed to go into residential care as her condition appeared to be deteriorating. Just Checking showed that she was getting up in the night to use the bathroom and then going downstairs; this lack of sleep was affecting her level of functioning. By working with the care providers to make bed times later, this alleviated the issue of her waking in the night, and she was able to function much more happily within her own home.
But the proportion of the general population that understands this technology and recognises its benefits is small. A recent survey of 2069 UK adults by YouGov, commissioned by charity Carers UK, demonstrates the lack of awareness of the role technology can play in caring. When asked if they would use telecare (of which an activity monitoring system is an example) prior to an explanation of what it involves, just over 12% said they would use it. However, once it was explained the figure rose significantly, with 79% saying they would use telecare as long as it was affordable.
Without a good understanding of the benefits of telecare for all involved some argue that the use of technology undermines the provision of care, saying that it is being used to remove the need to visit and so leaves people isolated. The evidence suggests the opposite. Technology is not a replacement for care and using activity monitoring is not about 'removing' necessary care visits. It enables need to be assessed objectively and so care can be targeted where it can be most effective.
How can we spread the word about the technology, overcome any reticence and reach a position where decisions about care are made on the basis of an individual's objectively assessed need?
Simon Price is the creator of Just Checking, an activity monitoring system designed to help people with dementia stay in their own homes. The system is used by more than 80% of local authorities as part of their assessment process.
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