Key learning / Lessons learnt
The model shows the benefits of commissioning large-scale services with multiple stakeholders; however this requires significant upfront investment and a coordinated approach to be successful. Such services cannot be delivered in isolation or used as a replacement for human contact, but should be used as an enabling tool to support effective care outcomes.
The Televida teleassistance service combines telecare monitoring and response, coordinates social care and third party services and delivers proactive outbound contact from monitoring centres. Teleassistance aims to provide continued contact and support to older and vulnerable people in the community, helping them to remain independent for as long as possible and delay or avoid the need for more complex interventions. Barcelona's SLT is one example, which has been delivered by Televida since 2005. Commissioned by Barcelona Provincial Council in conjunction with the municipalities in the province, the SLT has grown considerably, from 3,800 service users to almost 70,000 today. Currently 10% of people aged 65 years and over and 25% of people aged over 80 receive the SLT service.
What challenge did we seek to solve
Barcelona has an ageing population, with an associated increase in people with long-term health and care needs. The Spanish economy has been weak in recent years, leading to cuts in central funding and the requirement for councils to deliver more for less.
What did we do
Televida uses advanced, bespoke monitoring centre software to manage calls and data, prompting operator workflow and creating an in-depth audit trail.
Lifeline home units and personal pendants are given to service users, enabling them to raise a call for help at the touch of a button from anywhere in their home, 24 hours a day. The teleassistance service can also provide more advanced telecare such as falls, smoke, gas and carbon monoxide detectors and sensors which monitor activity/inactivity. Today there are more than 5,500 of these sensors in operation.
The service provides people who are older and/or have long-term care needs with a range of support including:
• Telecare systems
• Home care
• Emergency response units
• Prevention and wellbeing services
Including prevention in the delivery model has been a key contributor to the success of the teleassistance service. It has significantly reduced the number of emergency service escalations, improved the wellbeing of users and made effective use of public services. Operators at the monitoring centre answer incoming calls in an average time of less than 10 seconds, and approximately 60% of calls are outbound. Operators proactively call service users on a regular basis to check on their wellbeing, remind them of appointments, prompt them to take medication, confirm medication has been delivered or wish them a happy birthday. The frequency of contact is adjusted depending upon the needs of the individual. Operators will also contact service users who experience a crisis, such as a bereavement, to offer reassurance and assess their mood and health. Special protocols and skilled staff are in place to support service users where there is risk of suicide or abuse, and in the event of major disasters.
Additional service elements
• Public Health
• Advanced technologies to support users
• Inter-municipal network
Logistically, Barcelona is a large and congested city and the teleassistance Service Level Agreement requires that responders must reach addresses in Barcelona within 30 minutes, and so motorbikes are used to negotiate busy roads. Each vehicle is equipped with medical equipment and manned by specialist trained social care technicians offering swift support; for example first aid, helping users after a fall and supporting people who feel depressed.
Some of the people supported by the teleassistance service have difficulties communicating, so Televida developed CareChat, which enables them to access the service using smartphones and a decision tree with predefined pictograms and text.
The teleassistance model offers tailored support, with preventative, proactive support for more independent service users, and increased levels of support for vulnerable or at risk service.
The model integrates statutory services to coordinate and prioritise care to ensure effective use of resources. The model is focused on providing preventative care where possible, helping to prevent residential care and hospital admissions by improving safety and promoting healthy lifestyles and self-care where possible.
The service also reduces social isolation by using proactive calling, improving wellbeing.
Teleassistance provides preventative, proactive support to more independent service users. Care services are prioritised and coordinated to ensure resources are used effectively and focused on the areas where they will deliver the best outcomes. The service has significantly delayed unwanted moves into residential care, and reduced emergency calls from end users and their families which has correspondingly reduced ambulance call outs and A&E attendances.
The Fundación Salud y Envejecimiento UAB, FSiE-UAB (Health and Ageing Foundation of the Autonomous University of Barcelona) is a non-profit entity that works as a research and knowledge-transfer centre specialised in health sciences, ageing and health and social care. It undertook a study of the impact of the telecare service, based on the data generated by a phone survey that took place between November 2015 and February 2016 calling two distinct groups:
• Intervention group: 500 elderly people who have used the telecare service for 6 months.
• Control group: 700 elderly people who are on a waiting list to have the service installed.
Both groups share similar characteristics with regards to their socio-demographic background, health, a need for personal support and help with daily basic tasks and a need for social support. Both the intervention group and the control group have been asked about their situation at the time the survey took place and their situation 6 months prior to it. 67% of the users selected to take part in the survey accepted to do so and the impact assessment was carried out in accordance with the difference in differences method (DID).
Results are shown in the table below (NB 061 refers to the Spanish emergency services telephone number).
Future plans are to continue delivering the teleassistance service, and expand its use into more areas of Spain.