Will the coroner ask the right question? (UK)

Mrs Kathleen Cliff, aged 74 died in hospital two weeks after a fall. She lay on her floor all night until a neighbour found her. Her phone and pendant alarm (PERS or medical alarm button for our American readers) were out of reach. Our condolences to her family, who are now encouraging other alarm users to wear their pendants at all times.

We hope the coroner asks the right question. Not “How can people be encouraged to wear their pendants?” But “Why was this lady not using a system that does not rely on someone’s active participation to raise an alarm?” Considering such systems have been available since the turn of this century, services that do not offer these options should surely now carry some of the blame for such deaths?

‘This little pendant could save your life’ The Star (Sheffield)

5 thoughts on “Will the coroner ask the right question? (UK)

  1. I hope that the coroner is provided with lots more information before taking a pop at Mrs Cliff’s social alarm service – and then seeks further expert advice before jumping to the conclusion that there has to be someone to blame for what sounds like a tragic accident.

    What seems clear is that the lady might have been found sooner if she had been carrying or wearing her alarm trigger. Did she forget about it, or did she deliberately choose to keep it in a drawer because, at 74, she was too young and active to suffer a fall? We may never know the answers – but we also don’t know how great the risk of a fall was, nor whether this lady would have accepted a more intrusive monitoring system that she couldn’t choose to switch off at times.

    Whatever the facts are, and whatever questions the coroner might ask, it is likely (based on my experience) that Mrs Cliff was not formally or fully assessed for the risk of falling nor was her likelihood of not carrying her pendant alarm considered. If a correct profile had been developed, and the risk of falling and being left on the ground considered to be great (and that would include looking at both intrinsic and extrinsic factors), then she could have been prescribed the most appropriate technology to fit her needs. It is likely that this would have included smarter sensors including bed or bathroom occupancy monitors and automatic lights which would both have reduced the level of risk and prevented a situation arising where she was left on the floor for many hours.

    The technology to detect falls has been around for many years but as more devices appear, the options increase, as do the chances of making the wrong selection. The starting point has to be a detailed and assessment of risk followed by an individual matching of telecare to that person’s lifestyle and needs. So rather than call for more sophisticated technologies, let’s first improve the training of health, social care and housing professionals so that the telecare prescriptions are more appropriate.

  2. Totally agreee with Kevin.
    Got to remember other factors such as cost, she most probably wasn’t assessed and as a paying customer probably never would be assessed so long as she stayed independent. Any assessment on a paying customer can be seen as a sales tactic by some.

  3. First, may I say it wasn’t my intention to ‘have a pop’ at Mrs Cliff’s telecare provider. I have no idea whether or not they offer ‘passive’ alarm systems such as fridge- or kettle-based alarms or a safety confirmation system, or whether or not the service had offered them to her. I was just saying it was a question that the coroner should ask.

    My wider point is that when you are stuck with only the Grim Reaper for company the last thing you are likely to be thinking is ‘I wish the occupational therapist (or telecare service) had done a better assessment’. Panic in that situation is a miserable experience as I can now testify: http://www.telecareaware.com/index.php/leaping-from-a-towering-inferno-is-no-longer-my-worst-nightmare

    However, if you were in Mrs Cliff’s position and could not raise the alarm for whatever reason but you knew that someone would come looking for you in the morning because an alarm would be raised automatically, the worst part of the experience would be mitigated.

    Who was it who came up with the statistic that if you phoned a lot of people who had been issued with pendant alarms 50% would not be wearing it when they answered? Now that alternative systems exist services should not be able to wash their hands just because a pendant owner is human and does not carry the button 24 hours a day.

    It is over seven years since the Telecare Policy Collaborative was set up with the explicit purpose of promoting the adoption of passive alarms (‘telecare’ at the time) and where are we now? People are still being offered pendants as the first line of defence.

    I still think it was a great discredit to the Department of Health when it defined ‘telecare’ to include ‘community alarms’ in the document ‘Building Telecare Services in England’ for fear that councils would otherwise miss the Preventative Technologies Grant targets, and we are still seeing the sad result of that failure of nerve on its part.

  4. In their own ways, I think that both Kevin and Steve make good points. Kevin, with his great experience and insight in all things telecare, is right to worry about how incidents of this type could be reported by an ill-informed hack. Bad press could still destroy this industry. Anyway, it must surely be better to have no more than a button and a box than to have nothing at all.

    At the same time, Steve is right in condemning the decision to include social alarms in the telecare head count back in 2006. It follows directly that councils (and the NHS too) can remain complacent about their lack of staff training in understanding people, their needs and their preferences when prescribing telecare. This means that they will continue to dish out buttons and boxes when some more sophisticated telecare equipment is warranted (and available). There are issues of cost as Mike points out, but I doubt if the coroner would be impressed by that particular argument. Let’s hope that the coroner recommends increased investment in telecare services.

  5. In the article it states that Mrs Cliff declined the recommended medical treatment so there is a good chance that she also made informed choices about whether to wear her pendant … but we don’t know. Her family however should be receiving our support in encouraging others to wear their pendants; it cannot be easy sharing their grief so publicly.

    Responding particularly to Kevin and Steve’s comments … and making a link to a recent comment on another thread

    “… nor was her likelihood of not carrying her pendant alarm considered”

    I think you are likely right Kevin – one of the areas we often don’t train people in is “why might this not be effective?” and when I ask that question about dispersed alarms during training sessions I get blank looks to start with then I can see the light dawning. I have previously told the story, here on Telecare Aware, of a friend (not in the Authority where I work) and how educating her to use her pendant has been beneficial – she is the star of that section of the training I deliver; I use her story to show practitioners why, if we rely only on a ‘box and button’, we should ensure we consider the risk of someone choosing not to wear the button and/or press it. I go on to illustrate that with her hearing impairment a simple ‘box and button’ is not adequate; a dancer in her younger days, she is tickled pink to be in a starring role again and keeps asking how many people have I told her story to now?

    “… and where are we now? People are still being offered pendants as the first line of defence.”

    I agree it is a shame that it wasn’t done differently, Steve, however pendant alarms do work for many people and give them confidence to remain safely and independently at home; if we improve the efficacy by considering the “why might these fail?” question we have a quick to deploy and comparatively straightforward to use first line of defence. The concept is also almost a “brand” and as such many people know what a pendant alarm is.

    The question is why do we stop once that first line of defence is there? Well I think the answer is linked with the comment on the post about the North Yorkshire Telehealth (14.01.12) when Phil makes the observation that it appears that the horse is firmly before the cart … they bought equipment before/rather than changing their systems.

    A Local Authority providing a full responder dispersed alarm service is almost certainly doing so at a net loss to its balance sheet … with a stash of unused peripherals (someone ordered them in because they had a bit of spare money in a budget just before year end several years ago) whilst citizens are offered a ‘box and button’ with the occasional pressure mat thrown in for good luck and maybe, if the Care Manager remembers to check for vulnerability, dispersed alarm connected smoke/heat alerts.

    When challenged to provide fit for purpose alerts the usual answer is “we have a stock of pressure mats so we will just use those”. Care Managers understand that it is not the better solution but the box can be ticked, and so it is, they are not empowered to challenge the decision. Why don’t we go further? because “we don’t do that here! it isn’t our system of working …”

    If we don’t revise the systems we will keep doing the same and maybe add more dispersed alarms with more passive alerts (because they are on the shelf already) BUT if we looked jointly at the big picture, rather than focusing in on the bit we each do, we could quite easily change the systems and enable staff to make better supported decisions …

    … but like Steve said “that takes brave decisions” – sadly the White Elephant that is the public sector in the UK does not have a very good track record in “brave”? If the fear of bad publicity and litigation isn’t a powerful enough driver what is?

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