Photos by pikselstock and ParinPS/Adobe Stock, design by Ana Hale
Home sensors used for remote monitoring have the potential to help people receive quality care and support people to live independently in their own homes for longer. Home sensors are usually devices that are used to monitor a person’s environment (e.g. temperature, doors opening, kettle boiling, fridge being opened) or the person themselves (e.g. heart rate, movement). They can be used to alert of behaviours that require an urgent response (e.g. a fall or lack of movement) or they can identify patterns over time (e.g. sleeping, eating or toilet behaviours). However, this technology is not often used as part of usual care across England and there is little understanding as to how this could become part of the usual care people are offered.
What is the issue?
There is a growing need for social care services in a climate of funding cuts and workforce crisis. To help overcome the challenges with meeting the nature and scale of demand, policy-makers have proposed the use of digital technology and technology-enabled care. The social care system has historically been reactive in responding to people’s care needs, but there is a growing interest in proactive and preventative care to support people before they reach crisis point. Once a crisis point is reached, the care needs are often more complex and resource intensive.
Home sensors for remote monitoring can be used for proactive and preventative care. They can be used in the short-term whilst people are recovering from ill-health (called ‘reablement’) or used long-term to monitor people and detect changes in behaviours that require a response. The use of home sensors has shown some promise in small scale pilots, however, these are often not adopted, adapted or spread to other settings beyond this, meaning they are rarely part of usual care. There is a lack of systematic evidence to help decision makers who are considering whether to adopt, adapt and/or spread the technology in their own settings.
How did we help?
DECIDE (Digitally Enabled Care in Diverse Environments) is a centre for rapid evaluation of technology-enabled remote monitoring in health and care, funded by the National Institute for Health and Care Research Health and Social Care Delivery Research (NIHR HSDR). DECIDE is a partnership between the University of Oxford and RAND Europe.
The DECIDE Centre conducted a rapid evaluation of social care pathways that involve remote monitoring that uses home sensor technologies. The Digitising Social Care Transformation Directorate was the policy customer for this evaluation. The aim was to define good practice in the implementation and use of technology-enabled in-home monitoring ‘beyond the pilot’ and draw transferable lessons that can inform spread and scale up across social care. The findings should be helpful for informing policy decisions at a national level, support local system improvement and implementation, as well as be of wider interest to charities, diverse populations and scholars from a wide range of disciplines.
The evaluation involved three core phases:
Understanding the landscape of the use of home sensors in social care and identifying sites to learn from. This involved scoping conversations with service providers, a literature review and evaluability assessment.
In-depth research and analysis to learn from three sites implementing home sensors in social care. This focused on understanding the technology, care pathways and the system within which it operates, understanding stakeholder and service users’ experiences of engaging with the technology, and understanding the economic impact and value of this technology-enabled care pathway.
Contextualising insights against the evidence base and examining applicability across a broader range contexts. We held workshops engaging diverse communities such as service users, social care staff, systems leads at regional and national levels from across the United Kingdom, to reflect on findings from the case studies and help further refine learning and recommendations about adoption, adaption and spread.
What did we find?
Home sensors were used to for diverse purposes, including to monitor people’s movement within and between rooms, use of certain devices (e.g. kettle/microwave/coffee machines), opening/closing of external doors, use of beds/chairs, and room temperature.
The evidence base on the impacts of the home sensor enabled social care pathways is limited. However, service users, family members and staff perceived the use of home sensors to increase service user independence and safety and provide reassurance to family/informal caregivers. In addition, there were cases where sensor-enabled care pathways helped identify new healthcare needs, such as urinary tract infections, sleep disorders and low mood or ill-health (identified through changes in eating behaviours). Social care practitioners felt they helped provide more holistic and objective assessments and provided data to support conversations about people’s care needs. However, there were also some concerns raised about potential unintended consequences, such as increasing caregiver anxiety and demands, and exacerbating anxiety and paranoia of those with particular mental health conditions.
A lack of accessible and/or collected quantitative data on costs and outcomes prevented an economic analysis, and there is also a lack of robust economic analysis in the academic literature. Understanding whether home-sensor enabled care pathways in adult social care are good value for money remains an area warranting future research.
Key issues that influence the implementation of home-sensor enabled care pathways relate to:
the set-up and maintenance of the technology (e.g. having sufficient Wi-Fi connectivity, battery replacements, sensors getting broken or lost)
how the technology fits in with people’s live - those who have sensors in their homes and family and informal carers too (e.g. those with cognitive impairments forgetting about the sensors and needing reassurance, people changing their minds and not wanting sensors in their homes, the need to have informal carers to respond to the data)
helping social care staff develop the knowledge, skills and confidence using the technology (e.g. basic understanding of the technology, how to interpret the data and use it for decision making, and for which service users the technology is likely to benefit), and
having good relationships and processes for working with people in different organisations involved in the funding and delivery of home sensors programme.
What are our recommendations?
Decision makers need to focus on creating the data infrastructure that can help assess the cost-effectiveness of home sensor enabled care pathways and need to support these pathways for long enough for the services to embed and accrue evaluable impacts in relation to value for money. If good value for money, decision makers will need to support and resource changes to embed the use of home sensor technologies for proactive care sustainability and at scale. Particular attention should be paid to ensuring that the technology is dependable, the ‘wrap around’ support (setting up and maintenance, monitoring and responding to sensor data) is provided professionally, that care staff are supported to develop their skills and knowledge related to using the technology and acting on insights from the data, organisations work well together to deliver the services, and that there is useful data routinely collected to help with future evaluations.
