Home Care Innovation And Technology

Self-managing teams

You may have already heard of the Dutch ‘Buurtzorg’ model of care? It uses community oriented, self-managing teams typically made up of 10-12 people who decide amongst themselves how to organise their work, share responsibilities and make decisions. It is non-hierarchical. Instead it encourages autonomy, flexibility and faster decision making.

Buurtzorg also puts patient/service user self-management of care at the heart of how it operates. Personalisation is central, as is care teams having smaller, stable groups of people they support, with whom they develop a closer relationship and understanding of their needs and preferences.

Key principles of Buurtzorg are:

Teams are self-managed and non-hierarchical, with administrative support provided by a small back office and developmental support from coaches, keeping administrative costs very low.
Teams are made up of 12 care workers/nurses maximum
Typically each team serves 40-50 clients
Teams work with individuals and their existing support networks to provide care focused on continuity, flexibility, and enabling independence.
An integrated needs assessment is carried out which incorporates informal support networks and community assets.

Benefits

Across multiple studies Buurtzorg has helped deliver:

improved job satisfaction
better staff retention
fewer staff absences
client (service user) satisfaction
improved outcomes
greater independence and reduced ‘care consumption’
lower admissions to care homes, nursing homes or hospitals
greater productivity

UK Examples

Buurtzorg or similar models using self-managing teams and related principles are in use in both domiciliary care and community nursing in a number of services across the UK.

One great example is Wellbeing Teams. Founded in 2016 they are a domiciliary care provider that works in locations including Oxfordshire, Wigan and Thurrock. They use small neighbourhood-based teams, made up of staff that have autonomy and are trusted to build relationships with the people they care for, in line with each persons’ preferences.

Home care startup BelleVie has recently secured £2.1m of funding from a range of investors to scale up their operations in the North East of England and expand into Buckinghamshire. BelleVie have been inspired by the Buurtzorg model.

They use 10 person teams of self-managing ‘wellbeing support workers’. There is a much smaller layer of wellbeing support leaders and coaches, and an even smaller team managing IT, strategy, finance and marketing. Unlike in other organisations the pyramid is inverted, with people being cared for at the top, followed by the support workers, then their support team and finally the ‘Leadership Circle’

Changes required

Staff pay

Alongside the changes in how care services are structured (being much less hierarchical) Other changes are needed in order for implementation of Buurtzorg or similar models of care to be feasible. Wellbeing Teams use a salaried model for their care staff rather than paying by the hour, while BelleVie do not use zero hours contracts and are an accredited living wage employer.

This is going to be tricky for most home care providers to achieve, as most would already like pay staff more if they could, but can’t due to funding being so tight.

Even if pay isn’t increased right away, giving staff more autonomy and ownership can improve satisfaction and reduce stress.

Commissioning

The key change in making Buurtzorg feasible across the UK is a change in how care is commissioned, away from contact time and towards an outcome based model. This has long been talked about but still very patchy in implementation in the UK. Greater trust and better relationships between care providers and care commissioners is also required.

Take what you can from it

Even if you don’t roll out Buurtzorg in full, there should still be elements you can take from it and apply to your service, to help staff be more empowered, more embedded within communities and with clients, and share responsibilities across your teams rather than keeping them on the shoulders of a few.

You probably are aware of some of the core technology home care providers use to help them manage and deliver care more efficiently, safely, and improves quality. Namely home care rostering systems and digital care planning.

The care sector still has a way to go in adopting digital care records, with less than 50% of care providers in England using them, however I feel this isn’t because care providers are unaware these systems exist, and despite those systems constantly evolving, I don’t feel they need to be covered as innovative here.

Artificial Intelligence (AI) and Machine Learning

Artificial intelligence might end up being 2023’s buzzword. The rise of ChatGPT and similar machine learning driven chatbots has led to acclaim and alarm in equal measure about their potential impacts on every sector, and on many jobs.

The use of AI and machine learning in home care is still in its infancy, but there are a few examples being either tested or imagined right now:

Schedule and route plan optimization for care workers (one pilot scheme in Bristol and Cornwall saw a 40% mileage reduction and 25% increase in workforce utilisation with no reduction in care for service users).
Machine learning to identify signs of deterioration or early indicators of ill health less visible to humans
Identifying signs of pain using facial recognition and AI in people who cannot reliably self-report their pain
Assisting in calculating risk (for example in falls risks assessments)
Automating processes, for example recommending follow-up actions following an assessment, audit or incident

These are just some examples of where AI and machine learning have been used in home care to date. The sophistication of these technologies is now speeding up and given they have uses across almost every sector you can think of, including the military, they will receive even more funding and interest to further increase how effective they are.

Details on how much militaries are investing is a little hard to come by as you might expect. But the competitive wrangling and billions of dollars being pushed into AI by Google and Microsoft should be evidence enough that the technology has recently taken on a new level of serious backing.

These developments will inevitably result in technologies for social care at some point.

AI and machine learning can cause concern. Staff may fear for their jobs or how they might change. Everyone concerned with the welfare of people being cared for may fear people being overridden in decisions about their care or treated more coldly, as a number rather than an individual.

However, where AI and machine learning has been deployed elsewhere, such as in healthcare, the focus has been to support and assist health and care professionals, as a useful tool rather than an overbearing, all-knowing master.

AI and machine learning does what computers do best, but better. Processing data and making calculations, much faster than us humans could ever do so. It takes this burdensome, time consuming work off our shoulders and serves us up insights based on the numbers and patterns it has processed, giving us genuinely useful information to help us make the right decisions more easily and reliably.

But the decision making power still lies with us.

Combining AI and machine learning with the next item on our list (Next generation telecare/telehealth) is going to really take things to a new level. Helping domiciliary care providers and local authorities to plan, manage and deliver care with much greater safety, quality and efficiency.

Next generation telecare/telehealth

One of the ground-breaking innovations in home care right now goes by a number of different names; digital telecare, remote monitoring, technology enabled care are some of its monickers.

One prominent, particularly innovative example that I know well incorporates elements of AI and machine learning, which was first created by Alex Nash in 2015 while he was studying at Loughborough University.

After his grandfather was diagnosed with Dementia, Alex wanted to use the latest in technology, both physical devices and data analytics, to help keep his grandfather safe, maintain his independence and give peace of mind to himself and his family members.

As the solution he created developed further, enabling proactive care became a focus, as well as enabling care providers to make more intelligent decisions around care and enable a more preventive approach.

Local authorities across the UK are now adopting Alex's solution; Access Assure and similar digital telecare solutions to replace older telecare, but the benefits are much farther reaching than a simple switch to digital.

What is Access Assure?

Alex’s solution has two key components firstly, the ‘Memo Hub’, which is a small, sleek looking in-home device, that acts as a connecting point for suitable devices in the person’s home, such as motion sensors, wearable devices, call monitoring and any other connected devices including kettles, fridges or even doors.

The second crucial component is Access Assure’s analytics and dashboards. All of the data collected via the Memo Hub, from all the different connected devices, is processed by Access Assure and presented in an informative, practical way for you:

This means care managers can use the information to spot if something is wrong, for example early indicators that a person has fallen, deterioration of a person’s condition or decreased independence. You can then take action sooner than would otherwise be the case, or even make proactive interventions to step in before a person’s condition worsens.

Information from Access Assure’s dashboard has been used to make care plans more personalised and by providing notifications to family members it gives them peace of mind and reduces the need for them to contact the care agency for that reassurance:

“Great product. Great service. Completely reassured me being able to check mum was OK. I felt in control of being to ensure she was safe and well.”

With our latest integration, care workers gain visibility from the Access Assure Home Hub within our care planning mobile app solution so all information can be located in one place to deliver better proactive care. Care workers can benefit from this integration to allow seamless communications to take place between themselves and the individual, as well as the 2 solutions themselves as all visit information is pushed back to the Assure app so all loved ones can see the outcomes and feel reassured about the care delivered.

Care providers can also use systems like Access Assure to evidence progress to and achievement of specific outcomes. For example, if we want to achieve increased mobility or independence for a person, then actual data collected from the person’s home can be used to demonstrate that a person is moving more frequently, leaving home more frequently or preparing their own food for example.

It could be the technological key needed to make outcomes based commissioning and strengths based care a reality.

Awards

Alex won the Care Innovator award at The Great British Care Awards 2022 and came Highly Commended in the same category in 2023 for his and Access Assure’s continued strides forward to help improve care services and outcomes:

Alex has not only produced new technology to aid families and vulnerable people with dementia, but he has also grown a company that is now widely recognised within the health and care sector. He has a number of financial investors that believe in the same vision as him to produce that all important piece of mind for families of vulnerable people within their homes. Mr Nash’s moving inspiration gave light to why supporting vulnerable and elderly people within their homes not only gives people a piece of mind but provides the vulnerable people with a quality of life.

Measurable Impact

A 2020 study (part funded by NHSX) into the impact of Access Assure for domiciliary care service users recently discharged from hospital found that:

40% of care plans were updated as a result of the intel they gained – usually to be more personalised to the user
83% of families said it provided an increase or significant increase in reassurance and peace of mind
90% of app subscribers (family/next-of-kin) would be happy to recommend the service to a family or friend

Robots

The use of robots in social care has always come with a whiff of controversy and suspicion. Understandably. Social care is a complex field and requires more human warmth perhaps than any other. The use of robots is often suspected to be a way to try and overcome financial and staffing shortages, in a way that has little regard for the actual mental and physical health of people being cared for.

Robots are now being trialed in both residential and domiciliary care, primarily as a means of providing companionship and assistance, like the example featured in this BBC report:

Big in Japan?

Japan has been trying to create robots to care for older people for around two decades. By 2018 the Japanese government had spent over $300m on research and development for robotics in social care.

Many different robots have been developed as a result, including:

‘Hug’ and ‘Robear’ - robots that assist care workers with lifting people
Paro – a robot seal (yes like the animal) designed to offer a robotic form of animal therapy (good natured pooches must have pushed up their prices in Japan)
Pepper – a robot that runs exercise sessions with residents in care homes or people in their own homes

Despite the enormous investment and push from government to make robot carers a reality, they haven’t really taken off. A national survey in 2019 revealed that only 10% of social care providers had introduced any form of robotic assistant to care and there’s little sign this will change anytime soon.

What’s the problem?

The key drawback with robots in care, besides the ethical, quality, of safety considerations, is that where they have been tried (most notably in Japan) they have actually created additional labour for staff, who have to move, maintain, intervene, set up and learn to use the robots. Similar attempts to introduce robots in Sweden, Denmark, Italy and other countries have met with similar problems.

The robots themselves have had limited effectiveness. Lifting robots proved uncomfortable for most and impractical even in a residential care setting. Whereas companion robots like Paro (the robotic seal) seemed to have stimulated more repetitive or obsessive behaviours in some people with dementia. It was hoped that the robot would reduce these kind of behaviours.

What’s ahead?

We’re still a long way from a robo-carer wheeling, or maybe walking, it’s way up your client’s garden path. But as the power of artificial intelligence progresses we will no doubt see lots of companies developing different types of solutions for care providers, for the next-of-kin consumer and for local authorities.

What is key is that the person being cared for, their wellbeing, their wants and needs are central in shaping the kinds of solutions being created and used.

James Wright, a research associate at the Alan Turing Institute and author of Robots Won’t Save Japan: An Ethnography of Eldercare Automation, points out that robots

“may act as a shiny, expensive distraction from tough choices about how we value people and allocate resources in our societies, encouraging policy makers to defer difficult decisions in the hope that future technologies will “save” society from the problems of an aging population.”

He proposed alternative approaches, such as, you guessed it; funding social care properly, paying care workers more and improving working conditions for staff.

Robots could well have a future in social care, but to date the approach and execution hasn’t been right.

Home Care Innovation and Technology - Summary

In this article I’ve looked at some interesting examples of innovation in home care. Of course there are many other examples of innovation left to examine, particularly in models of care such as:

Shared lives
Collaboration with community organisations and fellow care providers
Use of social prescribing to improve health, wellbeing and independence
Innovative commissioning models and relationships with local authorities
Training innovation, for example through the use of improved elearning in social care

I hope this article has sparked up some ideas for you and some practical steps you can take right now. Its clear that finding care robots to help take the strain is probably not a viable option yet, and might not ever be. But the principles of self-managing teams, of greater autonomy and empowerment of care teams, should give you food for thought.

Even if you can’t fully implement a Buurtzorg style model there are still some principles you can imbibe into your care services, how they operate and their underpinning culture.

AI and machine learning is still getting off the ground in home care, but the pace is set to quicken this year and onwards. As Access Assure is demonstrating, when you combine the physical devices needed to capture vital details on a person’s health and behaviour, with AI and machine learning to make sense of all that data, you have a seriously powerful tool. A tool that can help home care services and local authorities to be more ever present and cast a watchful eye over the people they are caring for. Enabling a proactive, preventative and the outcomes focused, strength based approach which has been talked about and aspired to for so long.

At The Access Group we will be at the forefront of using any technology we can to help our customers that provide home care to deliver their services more efficiently, improve quality and safety. Take a look at our domiciliary care software or get in touch to talk through what you want to do and if we can help.