Assist North West Telecare : “At home and In-Touch” Using Technology to maintain independence 14 th December 2006 Colin Pye Business Development Director Liverpool Direct Limited

Telecare definition The use of Information and Communication Technology (ICT) to support independent living for older, frail and disabled people

People Driver - Why Telecare? Year Ratio Persons Aged to UK Long Term Healthcare Cost (£B) Support Ratio 1 UK Long Term Healthcare Cost 2 1.Office for National Statistics, Royal Commission Report into Long Term Care, 1999.

National Service Framework for Older People: “by 2006 (now!), an extra 100,000 people should be looked after at home” Patient centric care – single assessment process Bed-blocking – over 65s cost the NHS 1.3 million bed-days each year The power of the grey vote Political Drivers

Type of careNo of recipients Amount purchased in Average cost per client per year Total cost Nursing care85,9603,580,186 weeks £19,136£1,317 million Residential care163,30011,557,035 weeks £15,836£2,861 million Community based care 925,000150,000,000 hours £1,956£1,810 million Assessment & management 1,088,300N/A£457£498 million Total1,088,300N/A£5,960£6,487 million Over £7.5B by 2026, without inflation! Financial Drivers - Cost of Care

The ‘Liverpool Telecare Project’ The service and technology trial of a new solution to help address the crises affecting the delivery of care to older people Enabling elderly and frail people to live more safely, securely and independently within the community (3.1M single pensioner households in the UK) Providing a new service and care option to Social Services to help raise care standards, increase efficiencies, promote client choice and reduce costs (£700M pa cost saving to local authorities)

Our Solution The use of non-invasive monitoring of a person’s activity levels, events and patterns of behaviour within their home to proactively alert the individual to situations of cause for concern To subsequently raise an automatic alarm to carers in the case of an un-remedied situation The use of adaptive algorithms based on Bayesian Decision Theory to generate personalised thresholds which incorporate real-life care provider policy (costs)

There are now 1.5 million alarm support systems in the UK which use simple technology to provide support to vulnerable people... … but systems using new technology could provide much better support. 1st Generation Telecare

Non-invasive home monitoring Data capture and analysis Automated alerting to client Automated alarm escalation to carer 2 nd Generation

Lifestyle Monitoring Non-invasive activity and environmental monitoring

Setting Thresholds How do we decide when to intervene? –Sensors indicate no movement in the house for a substantial period of time –Since the person is possibly incapacitated we have substantial risk and we want to be risk averse –We also wish to reduce overall costs to care providers –We need to use all the information available We want to make decisions in ways that are evidence-based, rational and equitable

Carer Voice call (PSTN) Liverpool Direct call centre Alert messaging Broadband Encrypted Voice call (PSTN) Monitoring data Internet Back office Management interface Data server Telecare platform Firewall Messaging server Voice server Monitored residence RMU Automated Voice Call (PSTN) Broadband Encrypted Carer Daily summaries

Results 21 Liverpool residents are/have been pilot clients Up to 16 clients online at once 1 st Client online 19 th February 2004 ~2500 automated telephone alert messages have been sent to the clients ~1300 of them being subsequently raised as alarms into LDL

In Home Alerts ~2,500 calls made to the clients for period of ~3,000 client days of data Average of 0.8 calls per client per day Spread is from 0.1 to 2.5 calls per day with median of 0.5 calls/day Analysis of automated voice calls (period 24/03/2004 – 14/01/2005) Result: IVR reduced number of alarms by around 40%

From Liverpool City Council… Tony Hunter, LCC Director of Social Services –Current President ADSS –“After the trial we would want to incorporate Telecare as a normal way of looking after older people.” –“Is Liverpool doing this to save money?” –“No, it is being done to enable people to stay in their homes, but any cost savings would be welcome as they would benefit other people in Liverpool.” Radio 4 interview.

© The Liverpool Four Layer Telecare Model Increasingly Pro-active Care Increasingly Re-active Care Healthcare interests – top down Social Care interests – bottom up Level 1 : SOCIAL ALARM Pendants Contact Centre Level 2 : SAFETY Sensors Security Alarm Level 3 : INDIVIDUAL Application Self-Learning algorithm Level 4 : CLINICAL Diabetic Care CHD COPD Each successive layer builds on the functionality of the previous one. The total service is underpinned by a common infrastructure that includes: Contact Centre staffed by Healthcare Professionals (Social Services and NHS) Engineering support for design, implementation and service Common Infrastructure and Support Services that apply to every layer BUILDING CONFIDENCE SUPPORTING SAFETY AND SECURITY RESPECTIVE INDIVIUALISATION DELIVERING CLINICAL CARE

The Benefits Dependency Network

Stakeholder table

3 rd Generation Telecare Builds upon 2 nd Generation Telecare –Immediate alarms Holistic well-being analysis –Pre-emptive, long term trend analysis Migrates Telecare from a crisis safety net to an assessment tool Will enable intervention outcome measures and optimisation of care packages

Av Err: 12% PERIOD TODAY 2 nd FALL MEDICATION CHANGE 1 st FALL PREDICTIVE REGION Well-being INDEX: (Without Intervention) HISTORY REGION STAIR LIFT INSTALLED CARE INTERVENTION STARTS Major Moderate Mild NoneINTERVENTION LEVEL: Accommodation Change Medication Change Without InterventionPREDICTION TYPE: X Care Well-being Index CALCULATE OPTIMISATION: X Cost (£ per Week) X

Example showing typical activity Client in bed between 11pm and 8:30am

Example showing cause for concern Client leaves dwelling at 10pm and does not return till 3am

Activities for monitoring Leaving & returning home Visitors Preparing food & eating Sleeping patterns Personal appearance Leisure activities Initial set of activities:

The Silence of the Lounge

Sample ‘Well-being’ interface Q4. Eating Habits Q3. Sleeping Habits

Pervasive ICT for wellbeing Holistic Well-Being Monitoring: Integration with health monitoring Chronic disease management Enabler for joined up care Opportunity for continuous objective measurement and support: Peace of mind for clients and carers Optimisation of home care services Timely intervention ahead of crises Government and consumer market Many questions still to be answered: Low cost ubiquitous sensor devices Scalable intelligent data analysis Seamless links to ICRS Privacy and ethics

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