TYC POST PROJECT EVALUATION

Transcription

1 TYC POST PROJECT EVALUATION Provider: SEHSCT Project/Enabler Title: TYC Telecare Prepared By: Position Held: Robert Moore (in lieu of J-A Augusto) Lead Nurse Primary Care Specialist Nursing Approved By: Position Held: Signed: Signed: Date: July 2015 Date: Section 1: Background Purpose of the Initiative: Telecare can be defined as: the remote or enhanced delivery of care services to people in their own home or a community setting by means of telecommunications and computerised services. Telecare usually refers to sensors and alerts which provide continuous, automatic and remote monitoring of care needs, emergencies and lifestyle changes, using information and communication technology (ICT) to trigger human responses, or shut down equipment to prevent hazards. For Older People: Telecare will enable more service users to remain safely at home for as long as possible and avoid unnecessary admissions to care homes/hospitals. It can also be used to support reablement models to facilitate people returning home. For service users with physical disability Telecare helps with balancing risks, promoting independence and supporting carers; For service users with mental health issues Telecare can support the reablement of patients resettled from long stay institutions; 1

2 For service users with a learning disability Telecare helps to promote the independence and personalisation of service and can also support the reablement of patients resettled from long stay institutions. By using telecare it was envisaged that the benefits to be realised include:- Reduction/delay of avoidable admissions to care homes o By addressing risks such as environmental hazards, falls and wandering Telecare can enable people to remain at home. Reduce the number of unplanned admissions and readmissions to hospital and facilitate discharge o By managing environmental risks accidents can be prevented. There is evidence that early awareness of falls reduces the amount of interventions required. Reduce/delay the need for other more expensive forms of intervention o Appropriate tailoring of a Telecare package can remove the need for, or at least reduce the amount of, domiciliary care required by a service user. Section 2: Assessment of Costs Approved Cost 2013/14 Actual Cost 2013/ Approved Cost 2014/15 Actual Cost 2014/15 Total Approved Cost Total Actual Cost Percentage variation between total approved cost and actual cost. 0% Explanation of variation in costs Section 3: Assessment of Benefits/Deliverables The benefits to be delivered, as per the approved investment, are outlined below: Benefits to be Delivered Benefits Actually Delivered Explanation for Variance By the end of 2014/15 deliver an additional 26,509 monitored patient days to the 58,841 to be delivered via recurrent funding ie a total of 85,350 monitored patient days 57,233 Figures supplied by Penny Hobson, e-health, HSCB In April 2014, 121 clients were utilising Telecare which had increased to 180 by March 2015 (increase of 59 clients or 33%). Despite a shortfall in the projected monitored patient days the momentum of the service has gathered (see details below) and numbers continue to steadily increase. 2

3 Deliver 4,546 net recurrent savings from 1 st April 15 i.e. (gross savings of 33,706 less recurrent costs of additional 26,509 monitored patient days of 29,160) Savings have been achieved in two areas:- 1. Costs related to residential and PNH care per week per client. 2. Containment or reduction of costs associated with empowering clients to be cared for in their own homes. Area 1 These can equate to 180 avoided or delayed admissions to residential homes i.e 470 per week per person saved or 593 per week saved, for Private Nursing Home Care (PNH) 180 clients in residential care: 84,600 OR 180 clients in PNH care: 106,740 By addressing risks such as environmental hazards, falls and wandering telecare can enable people to remain at home. Early intervention with falls prevention can also reduce the number of interventions required. Area 2 Avoidance of increasing domiciliary care costs by remodelling packages. For example: if one hour (at a rate of 11.90) of carer time was not required following the introduction of telecare for all 180 clients this would eqate to 2142) Appropriate tailoring of a Telecare package can remove the need for, or at least reduce the amount of, domiciliary care required by a service user. Other benefits: Reduction of psychological pressure on informal carers and improvement in the quality of life of health and social care users 3

4 Evaluation of Project To include an assessment of whether the project was completed on time and in line with the investment proposal/business case approved. The project was completed in the timeframe expected. However, the number of monitored patient days was not at the level outlined in the initial IPT. This is because there were not enough referrals within the timeframe to meet the target due to the low Nos of telecare key workers and unfamiliarity with telecare. However, in the last quarter, the momentum of the service has built up (more details below) and referrals continue to increase. In addition, with the new electronic telecare referral and service information on the Trust I-Connect intranet more staff are registering as telecare key workers to make referrals. Please also provide an assessment, with justification, if the provider is satisfied that the outputs delivered provided value for money. In 2013 there was additional non-recurrent TYC funding provided for telecare which was designed to enable care managers deliver social care in a different way, i.e. to augment community care packages more cost effectively by deploying telecare. At the end of the funding programme, 2-years, community care resources were to meet any on-going expense. In the first year there was only part-year effect funding of circa 9k and the Trust had a telecare system (Atlas) funded for Cedar Court in Downpatrick. In addition, TF3 were utilised for telecare packages for specific clients at risk of falls and wandering. Packages funded included exit alarms, falls pendants and mat sensors for a client group living with dementia. This equates to 9 tenants with a telecare package equating to 3285 monitored care days. The funds during the next full financial year were used to pay for the remaining service users from the 2008 Ulster University scheme equating to 27 service users, were receiving on-going packages linked to warfarin and diabetes management equating to 9855 MPDs. (U-Tell) The TYC funds (Cedar Court and U-Tell) and recurrent CCH telecare funds were combined and the annual target figure concomitantly increased. This formed a baseline of circa 184 service users on TF3 telecare service. At the outset of 2014/15, a target of MPDs was established with an end of year position of 57,233 MPDs - a shortfall of days (22%). In April 2014, the Trust had 121 clients utilising Telecare and ended in March 2015 with 180, an increase of 59 clients and a 33% increase in the number of people benefitting from the service. 4

5 However, in the first quarter of and although outside the TYC funding timeframe, steady progress is being made to increase the Nos of clients benefitting from Telecare. It is difficult to accurately quantify the cost benefits of telecare as it is not always the single contributory factor of an outcome. Community information systems are complex and largely manual therefore to identify the single contribution that telecare makes to client care is based on assumptions. However, in terms of value for money, if 180 clients did not require residential or private nursing home care, this made a major saving for the Trust as per the benefits column in section 3 above. Even, if those 180 clients had a domiciliary care package, the weekly cost of a telecare package would be cheaper than an hour of carer time. Domiciliary care is per hour and as a guide the permanent package may have been 1 hour less for those who receive a Telecare package. Is this Initiative able to be sustained by the Trust recurrently? YES/NO The TYC funding has enabled the Trust to start a journey with Telecare and has resulted in an increase in usage. However, momentum is increasing and more clients are benefiting across a number of programmes of care. It is envisaged that the Trust will be able to maintain a minimum baseline of 184 clients on Telecare monitoring. 5

6 Section 4: Lessons Learned Please provide an assessment of the key findings in implementing this project e.g. mobilisation issues, was the project able to be self-funding beyond the period of transitional funding provided, public feedback on the changes implemented, how the issues encountered would have been dealt with differently based on what you know now. It has taken time to get professional staff familiar with the TF3 monitoring service and the equipment that can be provided within a 24/7 monitored service. It is a journey of building up knowledge, experience and confidence. Referrals are not just related to the elderly, with referrals coming to the service from Adult and Disability Services. Assistive technologies appear to be making a difference to lives of clients and their carer s. They provide individuals with technology-enabled mechanisms for enhancing personal safety, maximizing independence, and supporting residence in their place of choice. The Trust has worked with the three generations of telecare: the first generation relating to simple, user-activated emergency response systems, the second generation encompassing automatic environmental (e.g., smoke, flood) or personal (e.g., falls) detectors, and the third generation providing functionality, such as lifestyle monitoring or remote support (Telehealth/Utell) Working with clients in their own home presents a challenge for health and social care professionals which is a fine balance between managing risk while providing choice and preserving independence. Interventions can be either preventative or reactive. The challenge is do we provide? - Upstream interventions: that aim to prevent harm before it occurs, which usually address whole populations and systems. - Midstream interventions: to address harm that has already occurred to mitigate the effects, which are usually targeted at groups or areas considered at risk. - Downstream interventions: to cope with the consequences of harm that has not or cannot be avoided, which are concerned with specific cases. From the learning over the last two years, SET is utilising telecare for mid or downstream interventions: where telecare is a measure to reduce risks in relation to harm that has already occurred and its provision is sufficient to reassure some health and social care professionals, family members and carers that risks had been addressed and the person could return to, or remain in, their own home. Section 5: Conclusions and Recommendations Conclusions 6

7 Telecare has been beneficial to a number of clients in this project. Lives are saved, ambulance call-outs reduced and hospital admissions avoided when assistive technologies talk linking environmental and physical/psychological risks. Telecare is not normally a short-term intervention, as people are living longer but this provides peace of mind for family members and carers. In a Trust residential setting (Cedar); telecare alerts have enabled staff to monitor their clients and manage risk without disempowering the client or their independence despite their clients memory loss or cognitive impairment with dementia. Technology can offer benefits to individuals and providers of care services - greater independence, enhanced safety, and reduced reliance on institutional care settings are all potential benefits of telecare applications. Users of telecare have reported feelings of empowerment and connectedness to professional caregivers. Recommendations As society ages, more and more people will have chronic conditions. Assistive technologies, alongside self-management by patient and carer, will help monitor, treat and even prevent such conditions, thereby improving quality and length life while also relieving pressure on increasingly stretched health and social care services. For a provider of social care services, telecare offers a wealth of opportunities in a period of austerity, with an aging population and increasing demand on social care services. As SET has the faster growing aging population there will obvious need for further use of telecare by service users. Key recommendations would include: 1. Ramping up service provision and create more robust metrics to quantify ongoing benefits 2. Standardisation of metrics associated with benefits of telecare and the capability to monitor metrics and clearly demonstrate impact upon health and social care 3. Realisation that the use of telecare will not stave the rising demand for acute services from an aging population and that future investment in technologies will be required particularly as preventative tool rather than reactive tool 7