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Assist North West Telecare : “At home and In-Touch” Using Technology to maintain independence 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 Telecare definition The use of Information and Communication Technology (ICT) to support independent living for older, frail and disabled people

Ratio Persons Aged 16 -64 to 65+ 4. 5 Support Ratio 50 1 UK Ratio Persons Aged 16 -64 to 65+ 4. 5 Support Ratio 50 1 UK Long Term Healthcare Cost 2 4. 0 45 40 35 3. 5 30 3. 0 25 20 2. 5 15 2. 0 1995 2005 2015 2025 2035 2045 UK Long Term Healthcare Cost (£B) People Driver - Why Telecare? 10 2055 Year 1. Office for National Statistics, 2002. 2. Royal Commission Report into Long Term Care, 1999.

Political Drivers • National Service Framework for Older People: “by 2006 (now!), an extra Political Drivers • 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 65 s cost the NHS 1. 3 million bed-days each year • The power of the grey vote

Financial Drivers - Cost of Care Type of care No of recipients Amount purchased Financial Drivers - Cost of Care Type of care No of recipients Amount purchased in 2001 -02 Average cost per client per year Total cost Nursing care 85, 960 3, 580, 186 £ 19, 136 £ 1, 317 million weeks Residential care 163, 300 11, 557, 035 weeks £ 15, 836 £ 2, 861 million Community based care 925, 000 150, 000 hours £ 1, 956 £ 1, 810 million Assessment & management 1, 088, 300 N/A £ 457 £ 498 million Total 1, 088, 300 N/A £ 5, 960 £ 6, 487 million Over £ 7. 5 B by 2026, without inflation!

The ‘Liverpool Telecare Project’ • The service and technology trial of a new solution 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. 1 M 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 (£ 700 M pa cost saving to local authorities)

Our Solution • The use of non-invasive monitoring of a person’s activity levels, events 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)

1 st Generation Telecare There are now 1. 5 million alarm support systems in 1 st Generation Telecare 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.

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

Lifestyle Monitoring • Non-invasive activity and environmental monitoring Lifestyle Monitoring • Non-invasive activity and environmental monitoring

Setting Thresholds • How do we decide when to intervene? – Sensors indicate no 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) Carer Daily summaries Liverpool Direct call centre Management Data interface Carer Voice call (PSTN) Carer Daily summaries Liverpool Direct call centre Management Data interface server Broadband Encrypted Alert messaging Back office Voice call (PSTN) Internet Firewall Monitoring data Monitored residence RMU Messaging Voice server Broadband Encrypted Automated Voice Call (PSTN) Telecare platform

Results • • 21 Liverpool residents are/have been pilot clients Up to 16 clients 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 Analysis of automated voice calls (period 24/03/2004 – 14/01/2005) • ~2, In Home Alerts Analysis of automated voice calls (period 24/03/2004 – 14/01/2005) • ~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 • Result: IVR reduced number of alarms by around 40%

From Liverpool City Council… • Tony Hunter, LCC Director of Social Services – Current 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.

Leve • Pen • Con BUILD CONF Leve • Pen • Con BUILD CONF

The Benefits Dependency Network The Benefits Dependency Network

Stakeholder table Stakeholder table

3 rd Generation Telecare • Builds upon 2 nd Generation Telecare – Immediate alarms 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

Well-being INDEX: HISTORY REGION 100 PREDICTIVE REGION 1 st FALL 80 MEDICATION CHANGE 50 Well-being INDEX: HISTORY REGION 100 PREDICTIVE REGION 1 st FALL 80 MEDICATION CHANGE 50 2 nd FALL (Without Intervention) 20 10 CARE INTERVENTION STARTS 04 STAIR LIFT INSTALLED 00 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 PERIOD TODAY INTERVENTION LEVEL: None Mild Moderate Major PREDICTION X TYPE: CALCULATE X OPTIMISATION: X Without Intervention Medication Change Accommodation Change Care Well-being Index Cost (£ per Week) Av Err: 12%

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

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

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

The Silence of the Lounge The Silence of the Lounge

Sample ‘Well-being’ interface Q 3. Sleeping Habits Q 4. Eating Habits Sample ‘Well-being’ interface Q 3. Sleeping Habits Q 4. Eating Habits

Pervasive ICT for wellbeing Holistic Well-Being Monitoring: • • • Integration with health monitoring Pervasive ICT for wellbeing Holistic Well-Being Monitoring: • • • Integration with health monitoring Chronic disease management Enabler for joined up care Many questions still to be answered: • • Low cost ubiquitous sensor devices Scalable intelligent data analysis Seamless links to ICRS Privacy and ethics 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

Thank You Contact: colin. pye@bt. com 0780 141 2193 Thank You Contact: colin. [email protected] com 0780 141 2193