The social care system in England is under great strain, with rising demand, budget cuts and a shrinking workforce (PDF). In the last decade several technology-enabled care initiatives have been trialled to help overcome some of these pressures, with a key focus on helping people live independently, at home, for longer.
One of these initiatives is the use of sensor technologies, which monitor a person’s activity in the home (for example, physical movement and the use of kettles or microwaves) and their home environment, including room temperature and the opening or closing of doors. The sensors are used to detect changes in patterns of behaviours and alert people that the person being monitored requires help before they reach a crisis point. This approach is broadly described as “proactive telecare”, and if implemented effectively it could bring a range of benefits: to individuals by preventing the personal distress of crisis points and to the wider health and social care system by reducing the associated resource costs.
While we found many positive aspects to the sensor-enabled care pathways, there were also some unintended consequences.
Proactive telecare has not yet become mainstream in social care but is being implemented and tested in some local authorities. The DECIDE (Digitally Enabled Care in Diverse Environments) rapid evaluation centre (a partnership between the University of Oxford and RAND Europe) worked with three councils in England who were using this type of technology to better understand what they were being used for, how they were being used and what impact they had. We spoke with 51 members of staff involved in implementing sensors in care pathways, as well as 19 people who had sensors installed in their homes or a family members home, combining these conversations with a review of existing literature of these and workshops with experts, practitioners, industry and the public. Our findings shed light on the actions needing to be taken before home-sensor enabled social care services become part of usual care across England.
While each service we assessed was set up and run slightly differently, the care pathways broadly followed the same steps:
1. Identification: Service users are identified based on criteria decided upon locally.
2. Assessment: Practitioners assess the suitability of the home sensors for the individuals’ needs and the appropriateness to their home environment. Service users are offered the home sensor care option and referred if they agree.
3. Installation: The home sensors are installed in the service users’ home, including providing Wi-Fi if they don’t already have it.
4. Monitoring, maintenance and responding: This can be done by family members and informal carers and/or a professional social care service.
5. Review: The usefulness of the sensors and the data they provide is reviewed periodically alongside the service users support needs and a decision is made to keep the sensors in place or to remove them.
6. Removal: When the sensors are no longer needed by the service user, they are removed by the installation team.
Our investigations identified that home sensors were useful for more comprehensive assessments of people’s social care needs, providing a 24/7 view of behaviours in addition to usual care assessment meetings. They also supported monitoring for individuals returning home after a period in hospital (reablement), and for assessing longer term changes in support needs. People we spoke to mentioned that sensors supported people’s independence while keeping them safe. Family members found this balance reassuring, particularly if their relative had memory or communication challenges. We also found examples of sensor data being used to identify healthcare needs. Monitoring of sleep disturbances for example leading to diagnosis of sleep apnoea, or frequent bathroom visits leading to diagnosis of urinary tract infection. In some cases, sensor data contributed to decision-making around the level of social care support people needed, including for example moves to residential care or the implementation of enhanced care packages.
While we found many positive aspects to the sensor-enabled care pathways there were also some unintended consequences. False alerts triggered by the sensors could be disruptive to both patients and carers, while the increased burden on informal carers to monitor made it difficult for them to “switch off” from their responsibilities and raising their anxiety. Issues with the technology breaking or not working properly, worries about misinterpretation or overreliance on the sensor data, and concerns over the appropriateness of sensors for people with certain mental health conditions were all also raised as potential issues, alongside concerns about privacy and intrusiveness.
To mitigate these unintended consequences, we argue that five factors need to be considered before sensors become part of standard care. The first factor is funding. Many councils only have the budget to test home sensor-enabled care pathways short-term and do not have long-term funding plans to keep these programmes running. Decisionmakers are prevented from understanding the value for money of sensor care pathways (which, if proven cost-effective, would help to provide a case for longer term funding) because the data needed to do so isn’t being collected routinely, and isn’t easy to access. This lack of evidence is a significant obstacle to investment in these pathways.
Some service users and family members are worried about sensor technologies due to perceived issues around individual privacy.
The second factor is fragmentation. There are many different organisations and people required to work together to make the sensor-enabled care pathways successful, across social care, health care and involving families (including informal carers). To make this part of usual care, improvements need to be made to formalise partnership working and create a shared strategy for integrated technology-enabled social care.
Fitting into existing systems is another key requirement for effective implementation. The sensors (technology and care pathways) need to fit well into the lives of social care service users, their families/care networks, and existing care pathways. This requires training social care staff to understand the technology and data that results from the use of sensors, as well as understanding who is responsible for monitoring and acting on the data (“wrap around care”).
The fourth factor our evaluation revealed was the need for service providers to ensure they are developing a full picture of care recipients’ needs. The data from sensors only tells part of the story. Sensors cannot fully replace traditional assessments of social care need and the “human touch” in social care, and in fact relying purely on sensor data can be misleading. Sensors can enhance care by providing data to support conversations about needed types of care, so this is unlikely to “fix” issues with a shrinking workforce on its own.
The final factor which deserves greater attention is fear. Our evaluation highlighted that some service users and family members are worried about sensor technologies due to perceived issues around individual privacy, and the misinterpretation of data (if viewed in isolation) impacting on the care packages they receive. Without carefully considering these concerns and developing effective ways to communicate the benefits of home sensors, care providers will struggle to effectively implement these more widely.
Home sensors certainly have the potential to reduce pressures in the social care system and help prevent people receiving social care support from reaching crisis points. We are already seeing examples of positive impacts in pockets around England, but there is still a way to go before they are likely to become part of standard care. By addressing the five factors highlighted above, decisionmakers in the social care sector can ensure we maximise the upsides of these technologies while mitigating possible harms and building confidence among service users and their families.
