Activity monitoring to support people with dementia Ellen Bragger, Telecare Occupational Therapist, Just Checking Ltd

Just Checking Information system:  Supporting carers  Assessment tool

Mrs Bowler

Outcomes  Reduced homecare from 2 to 1 visit a day  More independence for Mrs B  Saving 3.5 hrs per wk x £13.60 = £47.60 = £2475 pa  Changed emphasis of homecare calls  Objective information about missed home care visits  More tailored care package, better value for money

Eileen Page

Background  Living with husband in an Extra Care apartment  Diagnosed with vascular dementia  Started having hallucinations, delusions and becoming aggressive towards family and staff  24 hour care required to complete specialist assessments and manage medications  While in care, Eileen’s husband passed away

 Eileen’s physical and mental health deteriorated in 24 hour care  Staff noted Eileen was slowing down and that more and more support was needed to maintain her daily physical and psychological needs  Family felt there were not enough meaningful activities to stimulate her day  Family wanted to Eileen to return home

What are the concerns?  Will Eileen manage at home?  Will she become distressed and leave her flat to look for people?  The medications have not stopped all the hallucinations  What will she do when alone at night?

Back Home First Month  Day centre staff report Eileen being able to manage her own behaviour and noted that if she was having an hallucination she would take herself away from group

 ‘The knee jerk reaction is to say we need to change the medications, but at a round table discussion we realised she was still ok during the day and not distressed or overly tired so we let her be’- Social Worker

 ‘Eileen is able to fill her time in her own flat, often found wiping benches and furniture was moved, ‘we think she is probably just cleaning up her flat’- Extra Care Staff  ‘The night time has proven to be less of a problem than we thought’- Care Call Staff

Just Checking System  ‘It did not make more work for us but helped the team to have discussions about questions and problems raised by the objective charts and then think and talk through what she was doing and how she appeared rather than jumping to assumptions and changing her medications or care plan’- Social Worker

Outcome MDT  ‘The best thing is that Eileen is managing her own behaviour, filling her time and her sense of humour is back’  ‘The balance of being in her own flat and going to the day centre has made Eileen far more settled than she ever was in 24 hour care’ -MDT Staff feedback

Outcome Family  Initially, the family were logging on 27 times between the hours 1am and 11pm  Within 2 months, the family were happy that Care Call and extra care staff were monitoring nights  Family continue to log on 2-8 times day  Family privately took over system

Outcome Family  ‘For now we are happy just to have stolen some time back from this awful illness, and we're enjoying spending time with her at home again’ -Eileen’s Daughter

Mrs Jennings

Mrs Kent

Importance of home 1. People with dementia are generally managing better than expected 2. Getting someone home helps to reinstate routines and daily living patterns 3.Observing how a person uses the space in their home is surprisingly powerful information

Cost Just Checking Professional  Equipment £688  7 sensors, mobile phone controller, carry case  Web-service £492 pa  Call charges included  Management system to re-designate users, set up access  Helpline for staff

Cost  3 year bundle cost for 1 system = £12.40 a week

Pays for itself if…  Residential care is postponed for just 2 weeks  1 hour less of home care is needed per week  1 short, daily ‘checking’ visit is not needed

Getting started  Start with a few key teams  Year 1 £1200, subsequent years £500  JC provides:  training and helpline for staff  help in developing protocol and evaluation  Work each system hard

Any Questions?  Ellen Bragger  Telecare Occupational Therapist   

 Equipped ‘Reablement’ teams with Just Checking  Helps to see:  level of service needed  effect of gradually withdrawing services – more autonomy  Autumn 08 Dept of Health evaluation 21 cases  - 2/3 stayed at home  - Cost savings: £2,300 per week £119,000 per annum 

 Mental health intermediate care service  Clearer assessment & reassurance to families that person is coping at home.  Night Roving team accesses Just Checking via smart phone.  1 year evaluation  48% reduction in residential care admissions  78% still living at home at 6 months, 57% at 1 year  63% with low level on-going support

“Just Checking is the AK47 of telecare …..simple, portable, powerful and very effective.” Andy Lomax, AT Project Manager, Manchester City Council

Ethics  Consent / capacity  4 Ethical principles: (Beauchamp & Childress)  Non-maleficence  Beneficence  Autonomy  Justice  Ethics of the alternative?