Tunstall has developed a set of remote care services consisting of four levels: reactive, proactive, personalised, and predictive services. When moving from the personal alarm service, i.e. the reactive service level, to another level, sensors and accessories are taken into use according to the client’s special needs. In the reactive level service, the client can use the alarm button worn as a bracelet or as a pendant around the neck to contact the Customer Care Centre which will provide support or send the necessary assistance. [2]
This Digi-HTA assessment concerns only the TSP alert processing system and the Lifeline Digital -personal alarm, which are part of the reactive level remote care services.
According to the company, the TSP alert processing system and the Lifeline Digital personal alarm aim to provide more cost-effective and better quality social and health care services. [1]
The users of the service are primarily clients who need support and safety for living at home. [1]
The Tunstall TSP system receives personal alarm alerts and forwards the assistance tasks. The system stores essential information about the clients, alerts, as well as incident-specific
instructions. The report produced by the system helps a professional to react to changes in the client’s circumstances and to recognise an increased need for home care services.
The company usually manufactures and delivers personal alarm devices to customers, but the system also supports the reception of alerts from other manufacturers’ personal alarm devices. [1]
Research evidence relating to the product under evaluation
In Spain, a longitudinal study funded by Tunstall was conducted in 2014ꟷ2018. The number of users of remote care services increased from 202,100 to 247,900 during the study period. The average age of service users had also increased, and the elderly increasingly lived at home with the help of remote care services. The purpose of the study was to find out whether the increasing age of remote care service users increases the number of ambulance and other alarms. The study analysed anonymous demographic data and the personalised service use of remote care service users.
The need, use, and impact of remote care services were assessed using registered assessment methods and stratification models developed in collaboration with the Foundation for Health and Ageing at the Universitat Autonoma de Barcelona (FSiE-UAB). This assessment method was introduced in 2016. In 2014ꟷ2016, the need and use of the service by service users had to be assessed retrospectively, so evaluations of research results made at this time must be treated with caution. From 2016 onwards, the assessment could be carried out in real time.
In this study, the majority of service users were at the reactive and proactive levels, and the highest, or predictive, level had the fewest users. The average age of service users was 79.88 years and 73.3% of them were women. The study calculated the number of different alerts per person per year and found that as of 2016 the number of ambulance alerts started to decrease by 33.3% by 2018. The number of other alerts, such as those addressed to relatives and security services, also decreased during the monitoring period. When all alerts are taken together, their number decreased by 27.9% during the monitoring period. The number of fire alarms increased, but their percentage share of all alarms was minute (0.003ꟷ0.006%). These results show that the introduction of remote care services has led to improvements in the safety of service users and reduced the need for urgent health services. [3]
In the United Kingdom, Sefton-based Careline, a home care provider for the elderly, introduced the Tunstall PNC SaaS (Software as a Service) software platform. Careline and Tunstall worked
closely together to ensure that the project was managed and implemented without impact on service users and that the data transfer was seamless. The objective was to transform the service with digital solutions and smarter workflows in order to increase capacity and thus improve the organisation’s ability to provide services in the long term. The training provided by Tunstall has helped Sefton Careline make the best use of technology to assist service users in various situations. [4]
Studies related to the product under assessment for which original study reports were not available at the time of assessment
Another study funded by Tunstall in Spain examined proactive level service users’ perceptions of key areas such as sense of security and maintaining independence and self-sufficiency through patient-reported outcome measures (PROMS). 1,200 service users participated in the study. The study compared the grades given by proactive remote care users with a control group that met the criteria for receiving remote care, but did not yet have it in use. Results showed that 96.1% of users reported that their sense of security has improved with the use of remote care. Prior to remote care, the average sense of security was 5.9 (on a scale of 0ꟷ10), which rose to 7.9 with proactive remote care. The results also revealed an increase in overall peace of mind among the users. [2]
A study funded by Tunstall and carried out by the Yorkshire Health Economic Consortium (YHEC) analysed the impact of remote care on social welfare costs within the Lancashire County Council (LCC). LCC social welfare clients from 2016ꟷ2017 were included in the study. The study used anonymised data and compared the costs incurred in remote care to those incurred by groups without remote care. Efforts were made to make the groups as similar as possible and the demographic data of the clients, such as age, gender, and overall health, were taken into account in the formation of the groups.
The weighted average costs of all clients receiving remote care were adjusted to the periods examined. The cost difference between the two groups was slightly over £4,500 per service user per year, after deducting the cost of remote care. The additional costs avoided through remote care underline its importance in managing the capacity of municipal services and the demand generated by an ageing population. The study demonstrates the potential of remote care as a cost-saving measure in social welfare, and at the time of the study in 2017, further studies on the benefits of health care were ongoing. [2]
Literature reviews
In the UK, a randomised and controlled study was conducted on the use of technology to support living at home in residents with dementia. The starting point of the study was the assumption that comprehensive assistive technology and remote care at home [5]
- enable patients with dementia to live at home longer than those who use less technology
- are cost-effective
- significantly reduce the number of serious risk situations, in particular hospitalisation
- reduce the burden and stress on family and informal carers
- improve the quality of life of dementia patients.
In the study, 495 participants were divided into two groups by lot:
- The intervention group (248 residents) had access to a comprehensive package of assistive devices and assistive technologies, where the devices were to support memory challenges and be recommended by a health or social care professional.
- The control group (247 residents) had an electronic emergency call button in addition to the usual aids (for example, a walker, a walking stick, a bed lift).
Residents in both groups were monitored for at least two years or until the residents moved to institutional care or died. Five assessments were carried out during the two-year monitoring period. The monitoring of those residents who still lived at home after two years continued for one year. During the last monitoring year, their situation was assessed over the phone every six months. Thus, the monitoring period lasted for a maximum of three years.
Comprehensive assistive technology and remote care did not extend the time spent living at home, nor did it reduce the burden or anxiety of the family members or caregivers compared to the basic package of assistive technology and remote care. At 104 weeks, there were no significant differences between the groups in the costs of health care and social services (average difference between intervention group and control group – £909 (GBP), 95% confidence interval CI (– £5,336 – £3,345) or social costs (average difference between intervention group and control group – £3,545, 95% CI (– £13,914 – £6,581). Participants experienced a reduction in quality-adjusted life years based on EuroQol-5 Dimensions questionnaire responses in the intervention group compared to the control group; the groups did not differ in the number of quality-adjusted life years based on the EuroQol-5 Dimensions questionnaire evaluated by the proxy server. [5]
The purpose of the personal alarm service is to enable the client to live in their own home. It partly replaces home care services where a nurse comes to the resident’s home. Simply put, the
longer a resident lives at home, the cheaper it becomes for society to employ the service. The costs of living in an assisted living unit are many times higher than living at home. The cost-effectiveness calculation of the personal alarm service can be conducted in many different ways, as presented by Vuolle in her thesis. [6]
Recommendations
Services for the elderly and mental health patients have shifted from round-the-clock care to homes or to home-like environments. Monitoring technology is used to increase safety and support functional capacity. Nevertheless, the introduction of technology must not replace face-to-face social contact. For example, the purchase of a personal alarm must not reduce the number of visits so that the elderly do not feel more lonely. Sufficient resources must be allocated to the maintenance of the technology, and the functionality of the equipment must be ensured. The service provider must also be prepared for situations where the technology does not work and ensure that the resident also receives assistance in these situations. [7]
