Project outcome for Norrbotten

iPad

Service description

IPads are tested in both municipalities as a tool for improved support for people with dementia (users) and their family. IPads have been used by the users and their family; the health care staff has used their computers. The video software solution Polycom CMA has been used for communication.

In Pajala, the iPads have been used for communication between family of persons with dementia and contact persons in home care, as well as between family and persons with dementia

I Arvidsjaur, the iPads are used by the users and their family to communicate with the home care services, home nursing services, and other health staff. Health staff uses PCs and web cameras. Healthcare staff is scheduled to call the users once per week for monitoring their general condition as well as clarifying of tasks. The users need to have broadband/mobile broadband connection installed in their homes to get access to the service.

Description of tests

In Pajala, seven persons with dementia were recruited to participate in the test by health staff at the Pajala Health Centre. Initially, five users got iPads, but one did not complete the test. The users tested the iPads for five months. The test included one weekly meeting between the contact person from the home care service and family of the person with dementia. These meetings included support and counselling, as well as information about available municipal services. The iPads were also used by the users for listening to music, reading and communicating with family.

In Arvidsjaur it was difficult to recruit test persons who are diagnosed with early dementia. The test has been carried out for six months with one test person recruited by the health care staff. The iPad was used for scheduled meetings for supervision and activity support. The service has depended on support from the municipal ICT-department, but there were still technical problems. 

The tests in both municipalities were delayed because the iPads arrived late, training was delayed and there were technical problems.

Costs and benefits

An iPad costs app. 4000 SEK (444€) in 2014. Broadband connection costs app. 300 SEK (33.3€) per month; annual costs are app. 3600 (400€) SEK.

The test in Pajala point to saved travel costs and saved travel time for health staff when face-to-face meetings are replaced by meetings via iPads. This is specifically important in rural areas where health care staff drives long distances to offer home care services to the users. The municipal family contact person has monthly saved one travel by car to each user during the testing period. One of the users lives 102 kilometres from the home care headquarters; 204 kilometres saved per month. The other users live in the same village, 67 kilometres from headquarters, and are normally visited at the same time; 134 kilometres saved per month. At a kilometre rate of 2.90 SEK (0.32€) (2014-prices), monthly saved travel costs for all users are 980 SEK (109€). Assuming an avoided travel time of 4 hours and 50 minutes, an additional 1008 SEK (112€) is saved . Annual saved costs are estimated at 23,856 SEK (2,651€) for these four users.

In Arvidsjaur, the test person lives in the main village, and no travel costs or travel time was saved during the test period. 

The tests have few participants and are too short to give conclusive evidence on saved costs and saved time for health staff. However, the longer the distances from the users to home care headquarters are, the greater are the savings for avoided travels.

It is reasonable to assume that investment costs and costs for training of staff are highest as the service is introduced. Later, the investment costs decrease, and as the service is included in normal routines, avoided costs or savings will increase. The tests in Pajala and Arvidsjaur showed that iPad meetings are often shorter than face-to-face meetings, mainly because all participants are well prepared for the issues they want to discuss. An evaluation of four different home care e-services in Väserås, Sweden also showed that visits via ICT are often shorter than physical visits. The RemoDem test did not provide sufficient data to quantify this benefit.

It is also assumed that the service may contribute to enhancing the feeling of safety for persons with dementia and their family, possibly resulting in delayed admittance in nursing homes. However, this has not been possible to document during the short testing period. The annual costs of a resident in a nursing home are 600 000 SEK (66,667€) and an average home care user costs annually 160 000 SEK (17,778€). A one year delay of admittance to nursing home means an average saved costs of 440,000 SEK (48,889€).

For the same reason, there may be a reduced demand for other home care services when ICT-services for easier contact and communication with home care staff are offered. A Swedish study points at an enhanced feeling of security and easy access to home care staff may not only reduce demand for home care services, but also for day care activities and other related services.

During the tests in Pajala, the average distance saved per user is 42.25 kilometres (one way) per month. This result indicates that it is probable that investments in this service will be paid back during the first year after implementation. However, this conclusion depends heavily on where users live.

Night cameras

Service description

Many persons with dementia living in their own homes need supervision during the night.  Home care staff is therefore scheduled to visit to check their condition at appointed times during the night. In Arvidsjaur, night cameras installed in the user’s home make these visits redundant. Health staff are able to check the user’s condition at scheduled times on their computers, without leaving their office. If the user needs assistance, health personnel will go to the user’s house and offer support in the traditional way. Pictures are not recorded or saved. No voice-based communication is possible. Healthcare staff has to log on to use the system, and all logons are saved in the system. The users need to have broadband installed in their homes to get access to the service.

Description of tests

In Arvidsjaur, the night camera was tested with two users for four months. One of the users was checked on twice each night: one physical visit and one “virtual” visit. The other user was checked on twice each night with the camera and expresses that these “virtual” visits made him/her fell safe. Both test persons live within one kilometre from the home care headquarter. The test will continue after the project has ended.

Night cameras were not tested in Pajala.

Costs and benefits

Leasing costs of night cameras are 1200-1900 SEK(133€-211€) per month [12]. In addition, the users must have broadband installed in their homes. The staff needed about four hours of training to be able to operate the equipment, estimated at 840 SEK (93€) per person. Technical support was needed when installing the cameras in the users’ homes.

The service is suitable for persons who are disturbed by the physical visits of the home care staff. However, the home care service in Arvidsjaur only offers nightly surveillance visits to persons who live close to the chief town and the home care headquarters. It is not possible for the staff to travel long distances to check the users’ condition every night. For the same reason, night cameras will only be offered to persons living close to headquarters - the staff will not be able to travel to assist users if support is needed. The service will therefore probably not result in saved costs.

The test did not produce sufficient data to conclude on the cost-effectiveness of the service or draft a business case.

GPS Wrist Band

Service description

GPS Wrist Band: In both Pajala and Arvidsjaur persons in the early stages of dementia have tested a GPS tool, the Posifon wrist band, to assist them to navigate when being outdoors. The wrist band contains a GPS, an alarm button and a mobile phone. It is possible to create a safety zone, and messages are transmitted to alarm recipients if the user moves outside the zone. When the user pushes the alarm button, the phone calls or sends messages to family or health staff. A map service informs of the user’s position. The Posifon wristband is connected to the mobile network and the wristband can be used for communication with the person with dementia outside the home. The tool is suitable for persons with early dementia who likes being outdoors.

Description of test

In Arvidsjaur, the Posifon wristband has been tested by two persons with dementia. One lives in a sheltered housing with family 250 kilometres away, the other lives with the spouse. Both alarms are linked to the test persons’ family. No alarms have been triggered during the test period. The wristband has been tested for four months and the test will continue after the end of the project.

In Pajala, four persons have tested the wristband. The alarms are linked to the user’s family. During the test period, there have been some false alarms to the relatives about the user being outside the safety zone because the GPS doesn’t function very well indoors. Real alarms have been answered by family who have been able to guide the user in the right direction.

Costs and benefits

In the municipalities the wristband is an alternative to the existing safety alarm. Posifon is a more expensive tool, about 9500 SEK (1,056€) per user the first year after implementation. This sum includes training of personnel as well as security centre.

Posifon must to be connected to the mobile network. Most persons in Sweden already have a mobile phone subscription.

Alarms triggered by the existing system are dispatched to the police, which is responsible for searching for missing persons. Alarms triggered by the wristband are dispatched to family during the test, but it is also possible for the home care service or the municipality to receive alarms. A cost-benefit analysis of the Posifon wristband indicates that costs for searching lost persons with dementia decreases if the alarm system is deployed to persons with dementia.

It is also assumed that the service may contribute to enhancing the feeling of safety for persons with dementia and their family, so that persons with dementia stay longer in their own homes. This argument was emphasized in an economic evaluation of the Posifon wristband in several municipalities in Sweden.

The short testing period and the low number of participants in the test render it difficult to draw conclusions. However, an analysis of economic consequences for several Swedish municipalities shows that the wristband is profitable during the first year after implementation. Saved costs include decreased search costs, postponed admittance in sheltered housing/nursing homes, reduced costs due to reduced need for accompaniment and reduced costs for the existing alarm service.

Strategy for Deployment in the Region

Arvidsjaur

The implementation of the services demands investments in equipment and training. In most cases, a technical support service must also be available. Allocation of funds for this purpose must be decided by the municipalities. The present organization has the necessary competencies to handle the new services, but will have to rely on ICT-support from other municipal departments.

Deployment of tested services

In Arvidsjaur, the iPad service did not work very well due to technical problems. The service will not be implemented between health care staff and users or their family. However, many users of municipal health and social services are allocated personal assistants to help them in their daily lives. The municipality plans to test iPads as a means for communication between the personal assistants and their supervisors, as well as between the assistants and their clients.  

The test of the GPS wristband showed positive results, but the municipality must allocate funds for investment in equipment if the home care service is going to provide the service permanently. The service has been easy to install without technical support from the ICT-department. It is not clear how many people with dementia in the municipality would benefit from the service.

The results from the tests of night cameras were also positive in Arvidsjaur. The service will only be offered to users living close to home care headquarters, so savings from avoided travels are not expected. The municipality wants to implement the service because it represents a quality improvement for many users. To implement the service, support from the municipal ICT-department is necessary. There are currently five potential users; one live outside the city centre.

Pajala

During the project period it has become evident that the project group in Pajala has had high ambitions for developing dementia services, but there are not enough resources available to carry out the plans and the organization has not been ready for development work. The development of dementia services demand close cooperation between the County Council and the municipalities, but the differences in how the organizations function render collaboration difficult. In addition, there are unsolved issues concerning the exchange of information between the two organizations.

However, there are plans for developing and formalizing continuous pathways for persons with dementia in the municipality (Lotsen). Some of the elements included in Lotsen are diagnosing and support after diagnosis, medical treatment and follow-up, municipal dementia contact persons, coordinated individual planning (study of the health and social services that dementia need), municipal dementia team. Technical aids such as security alarms are included in Lotsen.

Stakeholders involved are persons with dementia and their family, health care staff and other personnel in the municipality who through their work come in contact with persons with dementia and their family, as well as the rest of the community.

Deployment of tested services

The family contact persons think that the iPad service has worked well, but the decision whether to implement the service will be made by the municipality.

IPads can be used for many other purposes in the home care services. Physical supervision visits may be replaced by iPad visits. It is also possible for occupational therapists and physical therapists to follow-up the users via iPad. IPad services may also be suitable for other user groups. The more services the user’s iPad is used for, the higher the possible cost-effectiveness of the investment will be.

If the Posifon wristband is going to be a routine service in the municipality, it should be included in the normal allocation system. Because there are ethical issues concerning this service, a special procedure including the dementia team may be introduced. It is not clear how many people with dementia in the municipality that would benefit from the service.

Framework

The project has enabled the project group to continue working on good health and care services for persons with dementia in Pajala. The work builds especially on different projects carried out since 2006.

Continuous pathways for persons with dementia fit into both national and regional strategies, among other factors because these documents stress the importance of continuous care as well as cooperation between all professionals involved in assisting persons with dementia. The municipality will continue developing the concept, also by participating in other projects.

The Scottish concept

Based on the experiences from Western Isles, Pajala municipality plans to create a “Dementia Friendly Community”. The concept may involve activities and self-help groups for persons with dementia and for their family. Pajala is also interested in adopting the Scottish Community Awareness initiative, where businesses in the community receive training in supporting persons with dementia.

Published: 17/02/2013

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This is an excerpt from the complete Business plan and deployment report.