DTA

The Dependability Telecare Assessment (DTA) Tool and Person-Centred Telecare Assessment.

There are two methods of Telecare Assessment:

• Technology Focused

or

Premises and Rationales
The DTA tool and person centred assessment rests on 5 main precepts:
1. A good Telecare Assessment can enable a person to enhance their quality of life and encourage independence.
If a person has the wrong Telecare provision then there are a number of inefficiencies that have been documented and are apparent. False alerts resulting from poorly specified Telecare can have a number of negative outcomes, such as a client’s loss of confidence in Telecare, Professional’s loss of confidence in Telecare, and an increase in costs and rejection of Telecare.  This also means that a second or duplicate assessment is required to be undertaken before the new Telecare is provided, so extra resources are incurred.
2. A poor Telecare Assessment can disable the person and reduce their quality of life and lessen independence.
High-quality Telecare provision should enable a person to undertake activities and have an enhanced quality of life. It should delay a person from accessing more intensive services and allow them to have the choice to stay at home. Telecare following an enablement model has savings all around. Short cuts can be containing and expensive. So which is the best method of providing Telecare or social or health care for that matter?
3. Telecare is a safety-critical system – if the system fails a person might die.
4. It is important to note that Telecare takes the place of the carer:

• their eyes…
• their ears…
• their nose and…
• their intuition.

5. The DTA tool and person-centred Assessment are adapted from a full AT Assessment model called DMDS and a method called MDDS.  DTA is suitable for all Telecare assessments where more complex Telecare is likely.  It is not always required to employ this tool for simple pendant alarms specification.

Technology Focused Telecare Assessment

Available Telecare equipment + Risk (floods, falls, dementia etc) = Telecare solution

• The person has been relegated to being a set of risks
• This could also be called risk averse Telecare

The potential outcomes of this type of assessment include:
Mass produced Telecare packages for people (i.e. Falls, Mental Health etc).
Computer programmes - that provide a ‘best guess’ approach to risk assessment.
Remote assessments - can be done over the phone – Presents safeguarding issues as no home visit.
Self assessments – Client selects their own Telecare solutions from a list – Again possible safeguarding issues here.

Person-Centred Telecare Assessment

Person + Needs and Risks + Living environment + Support = Potential Telecare solution

• The person is fully integrated throughout the process.
• This could also be called a needs based Person-Centred Telecare Assessment.
• Begins with the person’s needs and expectations of solutions.
• Considers the property layout and the way in which the person lives.
• Considers dependability aspects of the person, the home and other factors, such as other support packages.
• Can arrive at the best solution which is “No Telecare” and may instead generate an urgent referral to other services.

Often an initial specification cannot be achieved due to the person’s living environment and other external factors (e.g. health, pets, family members etc).

The Dependability Telecare Assessment (DTA)

• Developed over ten years by the author at Lancaster University.
• Ensures essential factors are taken into account in the Assessment process.
• Based on the premise that the person is essential within and to the overall system.

The main elements of a Telecare assessment comprise of four things:
1) The person
2) The person’s needs
3) Their living environment and activity patterns
4) The Telecare options/ potentials.

These elements combine and the person is at the centre of the assessment process.

When conducting the assessment the assessor considers all the above factors.  Whilst considering Telecare they should also consider the dependability aspects of the system.

The four key aspects of Dependability form four properties ‘Fitness for Purpose’, ‘Trustworthiness’, ‘Acceptability’ and ‘Adaptability’.  Each of these dependability properties has elements within them that form the DTA tool:

The use of the DTA tool should be a cost effective method as it assists with ‘person-fit’ and this in turn makes the technology that is provided more likely to be suitable for the person.  This means there is less rejection of technology.  It also means that the ‘less is more’ approach is used in which the person receives the least technology to enable them to be as independent as possible.  This alleviates the dependency of Telecare and puts the emphasis and control with the person who is assessed.

Person-Centred Assessment
Key aspects of all assessment are:

• The user’s view of what they consider to be the problem, family / Carer’s should be consulted if available.
• The whole house approach, in which the assessor walks around the house and discusses where difficulties might occur, ideally with the person being assessed.
• Activity pattern based – knowing what the person does, when and with whom, what support is required and given etc.
• A discussion of other services that the person is receiving.
• A discussion of any Telecare solution recommended insuring the client is happy with this solution.
• A discussion on finances and payment if applicable.

Telecare is safety-critical; it must work, in the expected manner every time for it to be dependable. But technology alone is not the answer to a dependable Telecare service; the Response service is also safety-critical. If an alert occurs and nothing happens then the dependability of the system fails. Similarly if the Telecare device is not suitable for a person, i.e. they cannot press a button or pull a cord etc., then the dependability criteria are not met.

Comparing the Technology Focused Assessment with the Person-Centred Assessment