Co-evolving proactive telecare in practice

BACKGROUND Technology-enabled care (TEC) is viewed as at least a partial solution to the challenges of delivering social care. Telecare (continuous remote monitoring for safety and wellbeing using sensors and personal trigger alarms) has been widely used across social care for decades. However, mainstream telecare tends to provide a reactive service, in which an alert is triggered by the service user (e.g. push-button alarm) or passive detection (eg. fall detector). Whilst such forms of telecare have a role, they are limited by reliance on users to trigger alarms, and the alerts would mainly occur after an incident or crisis has occurred. The last decade has seen the emergence of various digital devices that offer potential to increase scope for more proactive telecare. This involves multiple digital devices for activity monitoring and outreach contact through communication technologies. Proactive telecare offers potential advantages to service users (e.g. more personalised support, increased independence) and the social care services (e.g. increased capacity). But it also raises concerns regarding impact on service access and quality of care. There are also significant challenges to incorporating such technology within social care practice. Whilst there is a lot of interest in proactive telecare, it has not become mainstream within social care, and there is limited knowledge on whether, how and in what circumstances it supports service users and care systems. In this study we will work with three care organisations to explore how proactive telecare can be implemented and used within routine care practice to support people living at home. The three case sites are at different stages in the development and scaling up of proactive telecare services. The project will study and inform the effective implementation and use of proactive telecare to support people at home, and establish wider learning across social care. AIMS To study and inform the implementation of proactive telecare, and draw transferable lessons on the nature of such services and how they can be effectively used and embedded within social care. METHODS Multi-level case study, using mixed-methods combined with action research. At the micro-level, we will conduct up to 30 ethnographic service user case studies on how (and the extent to which) the technology can be adapted and used alongside their care networks to address their needs and capabilities. At the meso-level, we will use qualitative and quantitative methods to establish the work processes and systems that need to change to introduce, embed and sustain proactive telecare. At macro-level, we will interview policymakers and other key stakeholders to understand the national context, and the wider-system drivers, facilitators and barriers. The analysis and action research will be guided by the NASSS framework. Data will be brought together from the three sites to illuminate the socio-technical challenges and changes needed for proactive telecare across sites. DISSEMINATION AND IMPACT Drawing on insights from the case studies, we will engage with other social care organisations and key stakeholders to establish wider lessons for social care on the implementation, use and evaluation of proactive telecare.