A reader has asked if anyone knows of a ‘decision tree’ that would help staff suggest appropriate telecare, telehealth or other equipment for people at different stages of dementia and in different settings. I’m sure many people are walking around with such a model in their heads, but has anyone formalised it? Please email me [editor Steve] if you know of such an aid and I’ll collate the results.
The Dependability Telecare Assessment tool
DTA (link here) was designed for the purpose of helping assess a person for telecare.
Of course it will not say which bit of kit is correct as it would be obsolete by the time it were developed.
Just because a person has a condition it does not mean that the process of assessment and the outcome will be any different. The basic rule of thumb is to consider the needs and wishes of the person and carers/family, etc. and that should lead you to a very narrow choice of telecare. Of course, you need to understand the properties of the telecare you are advocating as the same type of device will have different properties depending on the manufacturer.
Telecare and Dementia – Decision Trees
We’ve been down this route a few times – but tend to get bogged down somewhere between the assessment and the prescription, because it is apparent that there is no single solution that will work well in every case. The success of each item of equipment (and the most successful tend to be standalone rather than linked – hence the lack of publicity from the usual telecare suppliers) will depend on the individual’s:
1. Level of cognition – which can be measured
2. Ability to perform routines – which can be monitored
3. Level of informal carer support – which may be assumed (sometimes with errors)
4. Functional capabilities – which can be assessed
PLUS a range of individual preferences ranging from their willingness to carry or wear certain items, to their likely response to reminder messages coming out of unfamiliar objects
Thus, the skill is in matching a device to an identified problem area. I suspect that the variables may be so great that the decision tree may become a decision forest with separate trees for each identified need or risk. At the end of each tree there will be not one, but lots of different devices that might be tried. One might work for a while, and then you might need to try something else. So the prescriber needs a toolbox of equipment and, through discussions with the service user and the family, come up with some likely candidates to try.
I suspect that the toolbox is growing so big that it will need to be virtual if it is to include all the options, but each must come with some real-world advice on suitability (and value for money). This is the basis of the Telecare Equipment Prescription Guide (EPG) which has been developed by T-Cubed in conjunction with me and CUHTec members. It provides opinion on the suitability of devices for particular users – so avoids being simply an on-line catalogue.
I suspect that best practice will involve using a decision tree for the first part of the prescription process, but then the use of a tool such as the EPG to make the selection thereafter.