Assist North West
Telecare :
“At home and In-Touch”
Using Technology to maintain independence
14th 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
Ratio Persons Aged 16-64 to 65+
4.5
50
Support Ratio
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 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
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
150,000,000
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 £7.5B by 2026, without inflation!
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)
1st 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.
2nd 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
24.0
Temp
(Lounge)
22.0
PIR
(Bedroom)
257
PIR
(Lounge)
231
PIR
(Kitchen)
324
PIR
(Hall)
21
PIR
(Bathroom)
10
Closedoor
(Entrance Door)
8
Closedoor
(Fridge Door)
15
Activity
(CDEFGI)
865
FALSE
TRUE
AWAKE
ASLEEP
IN
OUT
ON
OFF
<
Minute
>
<
Hour
>
<
Day
>
0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30 0 30
0
1
2
3
4
5
6
7
8
9
10
11
12
4 April 1998
13
14
15
16
17
18
19
20
21
22
23
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
Carer
Voice call
(PSTN)
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
Messaging Voice
server server
Broadband
Encrypted
RMU
Automated Voice Call (PSTN)
Telecare
platform
Results
•
•
•
•
21 Liverpool residents are/have been pilot clients
Up to 16 clients online at once
1st Client online 19th February 2004
~2500 automated telephone alert messages have been sent to
the clients
• ~1300 of them being subsequently raised as alarms into LDL
Alarm Validity
Genuine
Other
Genuine
Missed PIR
Missed Contact
Sensor Fault
Spurious event
Other
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 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
Level 4 : CLINICAL
• Diabetic Care
•CHD
Level 3 : INDIVIDUAL
•COPD
• Application
DELIVERING
• Self-Learning algorithm
CLINICAL
CARE
Level 2 : SAFETY
RESPECTIVE
• Sensors
INDIVIUALISATION
• Security Alarm
Level 1 : SOCIAL ALARM
SUPPORTING
• Pendants
SAFETY
• Contact Centre
BUILDING
CONFIDENCE
AND
SECURITY
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
The Benefits Dependency Network
Stakeholder table
3rd Generation Telecare
• Builds upon 2nd 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
PREDICTIVE REGION
100
1st FALL
80
MEDICATION
CHANGE
50
2nd FALL
(Without Intervention)
20
10
04
CARE
INTERVENTION
STARTS
STAIR LIFT
INSTALLED
45
48
00
38
39
40
41
42
43
44
46
47
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 11pm and 8:30am
• Example showing cause for concern
• Client leaves dwelling at 10pm and does not return till 3am
Activities for monitoring
Social interaction
 Leaving and returning home
 Visitors
 Phone usage
 Writing
 Email
 Talking
Healthy lifestyle
 Physical activity vs. being sedentary
 Household chores
 Preparing food & eating appropriately
 Washing, taking a bath/shower
 Sleeping patterns
 Detachment from reality – too much TV
Self esteem
 Personal appearance
 Leisure activities
 Personal hygiene
Initial set of activities:
• Leaving & returning home
• Visitors
• Preparing food & eating
• Sleeping patterns
• Personal appearance
• Leisure activities
The Silence of the Lounge
Sample ‘Well-being’ interface
Q3. Sleeping Habits
Q4. Eating Habits
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