Undercover boss: Wearable Technology
Advances in sensor and artificial intelligence technology have spawned a new generation of wearable technologies with applications as diverse as HR and resident care.
Analysts Deloitte Global predict that by 2024, 440 million wearable units will be available worldwide as new devices come onto the market and service providers, including care home operators, become comfortable using them.
Devices that can detect and manage chronic health conditions at an early stage, preventing serious illness or distress, remain the mainstay of the market. However, new applications are being found, including in employee performance management.
During COVID the University of Leeds conducted a contract tracing feasibility study in care homes in Yorkshire using technology the size of a 20p piece worn on a bracelet or on a lanyard.
The aim was to add “real” information for contact tracing, said Professor Carl Thompson at the University of Leeds School of Healthcare. He explained: “In care, contact is unavoidable. We had to have a solution that could provide information about this unavoidable contact that could be useful for managers and their teams to think about infection control.”
However, during use, it became apparent that the devices also provided a lot of interesting information about personal relationships within the care home environment, for example, how long residents spend with each other, compared to members of staff, and, perhaps, more interestingly to managers, how long staff spend with each other rather than with residents. “Those pictures are not always what you would expect,” he said, adding that managers could use this data to see if this is “the quality situation” they want.
Back in the more usual application of illness prevention, the latest arrival is socks (pictured) that can detect distress in residents.
Backed by the Alzheimer’s Society, the Milbotix project is the brainchild of Dr Zeke Steer at Bristol Robotics Laboratory.
The key measurement taken by the socks is sweat, but there are also sensors that look at heart rate and heart rate variability, skin temperature and motion.
An algorithm analyses the received data and estimates whether somebody is in a state of distress, which can then be treated, or possible environmental triggers identified, before behaviour escalates. It aims to provide an objective measure of agitation and aggressive behaviours, especially for people on medication, he explained.
The footwear has only been tested on healthy older people so far, but should be piloted in homes at the end of this year. Another challenge is to integrate the socks’ data into electronic care planning systems, where it can provide the most benefit. Currently, it is
Presented as a standalone smart phone app with a dashboard that would sit within the nursing station.
Future developments include using the technology in falls prevention. However, at current 70 per cent accuracy, there remains some work to be done. “We are not looking to get the socks on to the market until mid-2023,” says Dr Steer.
Care Home Management: June 2022
SMARTENING UP THE HOME
Technology is one of the key ways the government hopes to solve the current workforce crisis in social care. By equipping care properties with the hardware to gather data and alert staff to any problem, it is hoping that these products can help fill in some of the gaps left by staff shortages.
At the heart of this will be the adoption of SMART (self-monitoring analysis and reporting technology) systems which can range from sensors that monitor residents’ movements to holistic software that can help plan or even prevent future interventions.
While ever present, these systems have the advantage of keeping residents safe but not physically intruding into their everyday lives. Furthermore, by using predictive analytics, escalations in people’s care and support needs can be identified and prevented, reducing hospital admissions as a result. The information gathered can be used to tailor care to the needs of individuals and improve the sharing of information across health and social care organisations, making for a more co-ordinated service.
Last July, the All Party Parliamentary Group for Assistive Technology (APPGAT)
held a roundtable to discuss the potential of SMART technologies to upgrade services and improve lives with parliamentarians, health and social care professionals, SMART home and assistive technology providers and charities.
It found there is still a gap between the potential of SMART home technology to support social care and independent living and the role products are currently capable of performing. It said: ‘In particular mainstream technologies are often not accessible or reliable enough to be used alongside specialist products in the care context.’
Operators also need to more effectively embed technology into provision, supporting staff to use it by creating dedicated roles within their organisation and empowering staff to develop the mix of technical and clinical skills to deliver high quality technology-enabled care services, it said.
The committee concluded: ‘There is an urgent need to develop a legislative and regulatory framework for the use of technology in care to ensure that people’s rights are protected and innovation is allowed to flourish.’
But while SMART technologies such as Amazon’s Alexa, Google Home, and Hive are becoming more common place in care properties, specialist SMART social care systems are also being adopted.
Colten Care has installed SMART technology into its homes to monitor call bell breaches in its 21 homes. Previous- ly staff were manually counting these breaches and generating reports six weeks later.
It now receives live data and daily reports from Courtney Thorne’s CT Cloud which has helped improve understanding of when and where calls are originating from, saved administrators’ time and instant access to the reports helps demonstrate responsiveness and safety during Care Quality Commission (CQC) inspections.
‘When it comes to CQC inspections,having instant access to reports helps prove our responsiveness’, explained operations director Elaine Farrer. ‘It’s easy for our home managers to demonstrate how responsive we have been over any period in question.
‘At the same time, we can clearly show that our homes are very safe places. You can’t put a price on the visibility we now have on a daily basis. It means we can spot trends, hold staff accountable for any breaches, and identify good practice so we can confidently ask the question: “Why is this not always the case across our entire portfolio?”. We can see what is happening now, not just what happened before.’
Housing with care provider Inspired Villages has invested in SMART technol- ogies in some of its communal areas to improve the health and wellbeing of the people who live there.
Chief operating officer Tom Lord explained that it believes in a holistic approach to wellbeing to help people physically, mentally and socially enjoy better years in their lives. By introducing technology into their retirement villag-
es, they aim to combat loneliness by connecting people within their develop- ments, while taking a socially prescriptive approach to ensuring people can remain healthier for longer.
For example, Inspired Villages carried out a 20-point health MOT pilot with a group of residents. This included giving residents activity trackers to improve
the number of steps they took each day. This turned into a competition among the residents.
Within six months every person within the trial group had a no fall risk and the proportion of residents assessed at normal cognitive function improved from a baseline of 38.2% to 72.4%. ‘We have found it to be a really great success,’
Lord said. ‘Simple technology, good technology motivates people to do this type of thing.’
They have since scaled this up in the villages’ health and fitness club facilities by installing an exercise wall that makes workouts fun using interactive technolo- gy. They have also partnered with eGym in three of its six villages so progress in strength training can be monitored. This has resulted in an average strength increase of 35%.
He said they were looking into install- ing SMART care technologies into their apartments but, as most residents might not need it immediately when they move in, it could easily become out-of-date.
Instead, Inspired researches and recommends systems when residents request it. Lord explained: ‘The perfect tech is still not out there to invest in our properties. What is needed is technology that is useful today but saves you tomorrow.’
He added that they would like something that links between care and wellbeing technologies. Currently activity trackers can monitor wellbeing but not report if someone has had a fall and care tech does not monitor health, but Lord said technology seems to be heading that way, in order to give everyone a wearable device that could do both. ‘We need some sort of life tech that brings the two together,’ he said.
‘If FitBits could record falls I would give one to everybody tomorrow. Today’s (care) technology comes with a stigma but a FitBit does not come with that.’
There is still a way to go if these types of technologies are to become standard in care properties.
A carehome.co.uk survey last year reported that a fifth of care homes had yet to install wi-fi. In addition, many modern building materials are not conducive to wi-fi signals which can hamper reception, rendering SMART technologies ineffective.
Currently it usually falls to individual operators or residents to introduce these technologies into homes but the APPGAT report calls for builders and architects to be brought into the discussion to ensure properties supporting vulnerable people can support SMART home systems.
There is also the issue of the workforce’s ability and willingness to embrace new systems. As the APPGAT report states: ‘Improving technology provision in social care services will require a sig- nificant shift in the culture of adult social services.
‘There is a shortage in technological skills among professionals across the health and social care sector. However, providing truly person-centric services will mean making sure social workers, occupational therapists, enablement teams and other services are able to perform effective assessments of people’s needs.’
But as Google, Amazon and other SMART technology companies start to develop specialist healthcare products, new social care products are expected to develop quickly, with voice systems like Alexa being used to call for help becoming commonplace.
‘These kinds of things will be the step forward,’ said Lord. But he cautioned that technology should not be introduced to replace the people providing care. ‘This is an everchanging world moving so quickly,’ he added. ‘It is exciting times for keeping people healthy and well.’
CARE MARKETS: MARCH 2020
Building bridges with data
The relationship between the NHS and social care providers has traditionally been problematic. But could new initiatives to share data help bridge the gap between the two sectors, asks freelance social care writer Eleanore Robinson?
Collecting and sharing information from social care providers and the NHS and, crucially, using it to make informed decisions, is something the TEC Services Association (TSA) has been trying to achieve through a series of leadership roundtables. Among the difficulties highlighted is a failure to optimise data, explains chief executive Alyson Scurfield: “We are collecting data but not intelligence. We do not maximise this data. We [need to] see how we can use that to get better outcomes for people.”
Among the examples of good practice in data optimisation is the Greater Manchester Health and Social Care Partnership, which is developing a ‘whole-system’ approach to health and care, linking up not just health and social care but housing too, in order that people might live in the community for up to five years longer.
“We want to take the data in the system and make it meaningful and get it to the right person, including data gathered from TEC devices”, Scurfield added. “You need a robust strategy like they have in Manchester. The community needs to work together. We are never going to achieve five quality years if you sit in silos.”
NHSmail
A key way of connecting care entities cross-sector is NHSMail. Social care operators achieving compliance through the Data Security and Protection Toolkit can apply to join this secure email service used by both central and local government to share confidential health and social care information. As well as being able to verify information with hospitals, GPs and local authorities, providers using the system can access training.
Swanton Care is one care home operator using NHSMail. It uses the system to send Deprivation of Liberty application forms and change of circumstances information, as well as sharing sensitive documents such as contract data with commissioners and local authorities.
“The people who have got it now say it is just so much more helpful to contact their GPs”, explained Daniel Casson, digital development executive at Care England. “There is so much work going on and social care needs to be part of that.” He said there are thousands of pieces of data being inputted each moment through electronic care plans. Families are recording information themselves, as are residents through feedback. “We are getting more qualitative information”, he said. This can feed into CQC inspections, giving consideration to the gathering of digital information when assessing if a care home is well-led.
Care England is part of a consortium of nine trade bodies behind the website www.digitalsocialcare.co.uk, launched in June, which is encouraging operators to embrace digital technologies. Another is the Registered Nursing Home Assocation (RNHA). Its digital engagement manager Katie Thorn said: “People feel there has been a change in attitude from the NHS towards social care. It varies region to region but it is a more collaborative approach.”
Thorn believes that a growing number of people are getting involved with NHSMail. She said: “It is a really positive change. At the end of the day it is about the culture, not the technology.”
This is a point echoed by the TSA. Scurfield said: “Good data will never be achieved without looking at the workforce culture. If you do not get people to see what better care can look like enabled by tech, you will never see a sea change.” To facilitate providers, the TSA is working on a new Level 2 qualification around digital care, which will be extended to senior management level.
Currently only one fifth of care homes have electronic care plans and some, not even broadband. Casson says: “With the smaller providers to get the take up is going to be very difficult as they might not even have broadband. But it is going to become a need to have rather than a nice to have.”
Care Home Management: December 2019
THE ROBOTS SPEARHEADING A CARE HOME TECHNOLOGY REVOLUTION
It may sound like science fiction but it is increasingly becoming science fact – robots are now an integral part of the care home environment.
As the ‘Alexa’ Amazon Echo technology is being trialled for social care by several councils, mechanised arms are being developed to lift patients without human assistance and Southend-on-Sea borough council has brought in its own robotic recruit – Pepper.
Council director of adult social care at the council Sharon Houlden said: “Robotics is not coming, it’s here. It is ground-breaking and it is interesting and not really spoken about in social care.”
Pepper costs £50k to buy but the council purchased it under academic licence for £17k as they are using him for research. Ms Houlden said that compared to, for example, buying a bariatric bed, it’s not that much money.
Pepper is a regular visitor to Priory House care home, Southend-on-Sea, which caters for older and frail residents.
Ms Houlden explains: “He acts as a master of ceremonies and question master during reminiscence sessions, and has an iPad to play videos and ‘Name that tune’. People then talk about what they saw and share memories. Care home staff can be as much a part of that as they want.
“Some people engage with Pepper as a person. It has generated a lot more ideas about what we can do. From a staff satisfaction point of view, it has brought the excitement back. We are in a very different place since we got him out of the box.”
Pepper is the latest in a not-so-long line of social robots being used in care. Perhaps, the most well-known is Paro the harp seal, developed in Japan to help people with dementia.
A study by the University of Brighton over the past three and a half years has found the furry robot has a calming effect on patients and provokes an emotional response that helps people socialise. The team are currently examining how Paro can be used without posing an infection risk (as he cannot be cleaned in a traditional way) and this autumn a new study will start into the robot’s role in reducing the need for medication.
Researcher Dr Kathy Martyn explained: “Paro can be used at any time of day or night. He does have the capacity to elicit human responses. He is the same size as a baby and has baby-like eyes. He makes a mewing noise when agitated. Most people do genderise them and give them names. People are rarely fearful.”
Dr Martyn also explained that Paro takes the form of a harp seal as very few people would ever have encountered one so the risk of a bad memory is much reduced compared with a cat or a dog.
She added: “They are several thousands of pounds, so a large initial outlay, but the benefit is, unlike real animals, he never has an off day.”
Robotic pets at Care South
Care home group Care South introduced robotic pets at two of its care homes six months ago. The animatronic pets at Kenwith Castle in Abbotsham, near Bideford, and Templeman House in Bournemouth respond to touch and speech from residents.
Robotic dogs KC and Biscuit (pictured, top) and pony Keno have been a hit among residents, according to Graham Brittain, director of residential care, providing stimulation, comfort and companionship. He said: “The residents love having the pets close at hand, so they can stroke them and give them lots of cuddles. Their engaging nature encourages the residents to interact with them and they have certainly become a talking point for our staff, residents and their families.
“Residents can often be found petting the robotic pets and reminiscing with one another about animals they owned previously and in childhood. Since their introduction to the homes, staff have seen improvements in some residents’ social interactions, particularly for those living with dementia. The robotic pets have also proved beneficial to residents in end-of-life care, who have taken comfort from the chance to touch and stroke the dogs, with carers noting the soothing effect they have and the pleasure displayed on their faces.”
While Care South’s new robotic residents were acquired second-hand, there are many similar models now on the market costing as little as £100, and the care home operator now plans to roll them out to its other care homes that look after people with dementia.
CARE HOME MANAGEMENT: MAY 2018
IN FOCUS: TECHNOLOGY AND SCHEMES
Eleanore Robinson examines how new technology is impacting on the schemes market for brokers.
The role of technology has never been more important in business and the schemes market is no exception. Data, e-trading and social media are all powerful tools that can help grow schemes and ensure brokers stay one step ahead of the competition. But does using technology have its limits and can it, if used incorrectly, actually cause harm to a business?
Drawing parallels with the recent US election result, David Sweeney, managing director, insurance, at Brightside Group, said social media was becoming increasingly important. He said: "Generating leads through personal recommendations will always be vital for a broker but publicity, endorsements (‘likes') and comments from social media are now becoming increasingly important.
Tool
There are lessons too from politics, where social media has become a key campaigning tool. In the US Presidential race, Donald Trump bypassed a critical mainstream media to speak directly to 15m followers via his twitter feed. "In an era where customer loyalty is at a premium, especially in personal lines, creating relationships with customers is a sort of modern Holy Grail.
"Furthermore, recommendations that come through social media can reduce the lead generation cost. Trump spent far less than Hillary Clinton on advertising."
Yutree Underwriting - established less than five years ago - used social media to build its brand. Director Laura High explained: "As a new schemes business, increasing our brand profile featured heavily in our early plan.
"Technology has enabled us to do this far more quickly than we could have done 10 years ago. Twitter, Facebook and LinkedIn have all provided an unprecedented reach for our product launches, technical pieces, blog posts and press releases."
She continued: "There are pitfalls to using social media for business but, in our opinion, as long as you have a strategy, remain aware of regulatory rules, engage with followers, are consistent and maintain your brand voice and identity then social media is a vital part of promoting schemes."
Automation
High added that the next stage for Yutree would be to use technology to automate all of its scheme policy document production. This will lead to efficiencies which will enable us to focus on our underwriting, relationships and sales efforts. She said: "We do not sell our products online and our proposition is based on strong relationship management and traditional underwriting principles. "Whilst this sounds old-fashioned, it is technology that has underpinned our delivery of this proposition and, without it, we would not have achieved the success that we have to date."
Richard Brunger, schemes product manager at insurer LV said technology was playing an ever increasing role in its schemes underwriting strategy, from initial research to full scale scheme management. He said: "At LV we are always looking for brokers who are able to bring expertise to their chosen sectors, and the use of social media or electronic marketing is an excellent way to get the product to market.
"We are also finding more brokers offering full cycle selling, via website or extranet sites, which enables today's more technology-conscious client to buy their insurance 24 hours a day, seven days a week."
Building
Simply Business built its own technology to streamline the process of developing and testing schemes, so set up can be achieved within days. At the same time, it says it can carry out the process with tailored journeys and rating models. Chief technical officer Lukas Oberhuber explained: "At every stage we take a customer-first approach, and this is reflected in our tech capabilities, which allow us to provide extremely specific products to a wide range of customers through mass customisation, while keeping the cost of managing the schemes under control. "Technology helps us to build successful schemes because it helps us know our customers."
He continued: "We are constantly looking at a huge and ever-growing range of data points, and through these, along with real-life interactions through our contact centre, we can build a picture of our customers and prospects that enables us to build schemes that cater for the extraordinary diversity of the UK's small businesses. "We're well on our way to becoming a truly data-driven company, helped in part by our in-house analysis system AERIE, which has had a major and quantifiable impact on the business through significant increases in monthly written premiums, better reporting to partners, and improved insight for our insurance teams."
Overview
From an insurers point of view, increased technology gives LV the ability to undertake improved due diligence on new opportunities, Brunger added. This means it can be more confident on a book of business from the outset and, therefore, hopefully not have any future surprises. It also enables LV to accurately map weather issues - one of the industries major challenges - much more effectively.
Brunger said: "Technological improvements in full cycle management of schemes can allow the broker's system to liaise directly with the insurer's system. "This negates the need for bordereau submission in some cases and can provide the ability to automatically provide risk data without manual intervention. This allows us, as underwriting businesses, to highlight potential problems earlier and solve them faster."
Brightside's Sweeney argued that relationship management now extends well beyond online purchase alone, with customers expecting not only to buy online but to be given great advice too, so the provision of advice will increasingly transition from the telephone to the internet. He said: "Client portals, where customers can store their documentation, ask for advice and track their claims are now ‘de rigeur.' The next step is for apps to be developed that allow mobile access to this information. "But with advantages come potential pitfalls, such as the risk of innocent non-disclosure if the information is not completely clear."
Sweeney added: "For sure, traditional telephone brokers will continue to play their part as there will always be customers who prefer to speak to someone than buy online. "In Brightside's experience, higher value clients are more likely to use a call centre as they want to talk to someone who understands their risks."
Buy-in
Oberhuber, however, said the most significant potential pitfall, would be a lack of buy-in when investing in technology. He said: "All too often, tech is looked at as a cost, rather than an investment. In order to make it work, you need the best people - and if you don't have those people, you're not going to get your return."