Responding promptly to a care home resident's call for help is essential. In this article, Mathijs de Bruin, managing director of the Dutch acoustic monitoring solutions company, CLB bv, describes an innovative approach that was introduced in the Netherlands nearly 20 years ago and is now standard, improving privacy and response times while saving money. Could it be the solution to problems here in the UK too?
Video monitoring is not a viable solution for dealing with social problems except in exceptional, limited and very specific circumstances
Some high-profile BBC Panorama and other reports on abuse in care homes in England have raised concerns about the quality of care delivered in some cases. Perhaps, predictably, there have been calls for installing CCTV to raise standards of care for vulnerable people. But video monitoring is not a viable solution for dealing with social problems except in exceptional, limited and very specific circumstances.
In the face of rising costs for care home residents in England, the Dilnot Commission, reporting in July 2011, recommended a cap of £35,000 on an individual's liability. The Care and Support Bill, currently with Parliament, seeks to implement this as well as introducing measures around safeguarding adults from neglect or abuse and requiring local healthcare providers to take responsibility for staff education and training. All this is important and desirable, but care homes face severe financial pressures with some already closing as a consequence. Balancing cost reductions with the need to maintain good staffing levels is difficult and requires increasing efficiencies.
Courtesy, consideration, empathy and rapid human support are all important elements and most care staff see these as central to their roles and the source of job satisfaction. However, staff also have to carry out routine time-consuming tasks which are essentially precautionary. In a typical care home, for instance, staff will look in on sleeping residents regularly, sometimes every half hour, sometimes only every couple of hours, often breaching patients' privacy and disturbing their sleep patterns. Nor is this very efficient – such rounds can take significant amounts of staff time and, if an incident occurs shortly after a visit, perhaps as a result of a disturbed resident getting up and then falling, it may be some considerable time before this is discovered on a later visit. Of course the widely-used nursecall system can help, but it is far from foolproof.
Lessons from overseas
Balancing cost reductions with the need to maintain good staffing levels is difficult and requires increasing efficiencies
This was the situation in the Netherlands perhaps 20 years ago when I noticed the problem as being particularly acute in homes for people with learning difficulties. Other homes often had nursecall systems, but in these homes there was rarely anything other than occasional baby monitors. We considered this and realised that our expertise in communications and security systems could be used to develop assistive technology to make the whole process of monitoring residents far more satisfactory for everyone. Essentially it was a matter of building a technology which waited unobtrusively until it picked up some indication of distress or a need for intervention and duly alerted staff.
This initiative met a clear need, driven initially by the importance of respecting residents' privacy, but more recently by the significant cost savings that can be made through improving efficiency. It is now inconceivable that the majority of Dutch care homes, whether catering for those with learning difficulties, for patients with dementia, or more generally for the elderly and frail, will operate without acoustic monitoring in place.. The system is perhaps particularly valuable where people live in their own apartments in the care home and where monitoring units can be installed in a living room and bathroom as well as in the bedroom.
The role of technology
It is important to recognise that this is something very different from eavesdropping on residents. Rather, acoustic monitoring is a specialist alarm system, tuned to individual need, which responds automatically to sounds – perhaps of someone falling, or making a sound of pain, or perhaps moving into the bathroom and not returning within a set period – and duly alerts staff to a potential problem, whether by flashing up a message on a screen or calling a mobile or handset. Staff can then listen in, perhaps talk to the resident, replay the sounds, and decide immediately what needs to be done. This means that a resident gets prompt help, but also that the staff concerned gain the job satisfaction of directly helping those in their care.
Essentially it was a matter of building a technology which waited unobtrusively until it picked up some indication of distress or a need for intervention and duly alerted staff
It is essential to gain residents' acceptance, but in fact virtually all residents welcome the system as one that gives them security while improving their privacy. Typically staff will switch on the system at night and switch it off next morning, although of course this will vary by need. The live system will show its status by sound or a light, and individual systems can be tuned to individual needs.
The UK situation is now very similar to how things were earlier in the Netherlands and the matter of reducing costs while maintaining or improving levels of care is one that resonates well with UK care home owners. In the Netherlands research shows that time saved by a typical staff member is around 20-40% in smaller homes, rising to 60% for larger ones. In terms of cost savings this translated into over £20,000 annually in the case of typical 15-bed homes or comparable institutions. Care homes in the UK can therefore now deploy mature, proven technology and so benefit from the long, practical experience of their Dutch colleagues.
