Means and Resources
Role of information technology
IT applications at the interfaces between formal and informal care
COUNTRY / LOCATION: France
Keywords: call centre, electronic alarm, isolation, frailty, volunteers, home maintenance, prevention
Keywords: call centre, electronic alarm, isolation, frailty, volunteers, home maintenance, prevention
Equinoxe - A home alarm system linked to volunteering
Summary
This French example has been ongoing since 1986. Created by the non-profit association “Equinoxe”, this nationwide home alarm system aims to maintain frail people living at home alone and enhance quality of life. Equinoxe started in a district of Paris with poor housing and service conditions for older people, working together with other voluntary services. The success and professionalisation of the system led to the independent association Equinoxe téléassistance. It is based on a complex high-tech call centre operating 24 hours a day with specially trained people. In order to participate, each older person must nominate a ‘neighbourhood committee’ which consists of about three people living nearby, holding a key to the older person’s house. They have a central role - when notified by the call centre after contact from an older person, they are sent to assess the situation, sort out the issue if possible, and/or help and support the older person if medical assistance is required. The call centre staff will continue monitoring until the issue is resolved and users benefit from feeling safe and secure while living alone at home. This service is entitled to public reimbursements through the national care attendance allowance scheme (APA).
In spite of a high turn-over rate of users (death; moving into residential care) and having to compete against many other providers, Equinoxe is steadily growing. At the end of June 2011, 40 paid employees managed the system with the help of 35 ‘staff’ volunteers for 8,756 users. On average, the users were 84 years old, called 13 times and used the service for about three years. They rated the service highly. Despite these outcomes, public information on the service’s availability is limited.
What is the main benefit for people in need of care and/or carers?
The target population can remain safely in their homes for longer, so older people can experience a better quality of life. The emotional burden on carers is lessened and they are able to carry on with their lives, secure in the knowledge that the continuous electronic assistance and the back-up of the local support committee is available.
What is the main message for practice and/or policy in relation to this sub-theme?
When well designed, this example demonstrates how home alarm systems can be a siginificant link in the chain of domiciliary care. To be efficient, these systems need to be based on a friendly, professional, high-tech call centre and close monitoring. This type of system should be considered as a core preventative measure against adverse effects in the homes of frail older people, not just to be used in an emergency. In order to produce the best outcomes, IT technology must be coupled with human resources at a central level (well trained staff for the call centre); local level (through regional centres and local partnerships with home care agencies); and at micro level with local committees of volunteers able to deliver quick interventions in the home.
Why was this example implemented?
It is well documented that frail and isolated older people, even those who are cognitively able, may be moved to institutions against their will. Reasons for this are that they feel insecure at home due to fear of adverse events (such as falls or not being able to carry out daily living activities without help); or because they are lonely and depressed even when they still benefit from relatives or neighbours leaving nearby. Also, families may be instrumental in institutionalising them as they are unaware of alternative solutions which would enable their older relative to continue living safely at home. The aim of this practice example was to solve these issues by designing a call centre managed by well trained staff and supported by local committees made of neighbours, family members and local professionals. The organisers of the home alarm system not only contributed to the set up of the committees and trigger their direct and timely intervention, but also developed a strong partnership with local actors in LTC, such as home care agencies.
Description
When the need for an older person to be linked into the call centre has been identified (by the older person themselves or through a family member, neighbour or professional) and is judged to be a feasible option for the older person (such as being able to organise a neighbour committee), a well trained technician will visit the older person in their home. The technician will assess the housing conditions and carefully explain to the user and the committee members how to use the technical device that reaches the call centre (inserted in a watch or a special button without using a phone). The technician will also explain that the centre is centrally managed (from Paris) by paid employees (17 corresponding to 11 FTE) working 24 hours a day, and Equinoxe works together with all other domiciliary care services linked to the user.
Once a call has been made, the call centre carefully analyses the situation supported by software providing all ‘live’ information about the older person’s circumstances. If the solution is straightforward, the call centre will resolve it without mobilising other resources. But whatever the need, the centre will involve one member of the neighbour committee, who will visit and either provide any physical or psychological assistance in the home, or will confirm the need for a professional service. With the latter, the committee member will make sure the older person is safe and secure while the call centre mobilises assistance. The call centre will be in constant contact with the family and the intervention team, and monitor the situation until the the issue is resolved. While this can be seen as responsive, another part of the service is more proactive in that those older people with high risk of adverse events receive systematic supervision through regular telephone calls.
Each call and intervention are electronically recorded and kept for two months for legal purposes. They are also used for training or supervision and as material for ‘experiential learning’ (see impact). The average monthly cost was 29 euros in 2010. To help support the cost of the service, older people with low income benefit from financial support through a solidarity fund managed by Equinoxe. Other users are sometimes supported by their health insurance company, retirement funds or through vouchers.
The call centre covers the entire territory, but is more developed in seven regions where there are locally trained staff and existing local partnerships. This results in 55% of the calls being directly managed by the centre in Paris while the remaining ones are managed by local committees and partners, making the system more flexible.
The budget for this system is € 2.1 million covered by payment from Equinoxe users. Extra resources are used to back-fill partner’s work and for developing new system functionalities (web site, new staff support software, evaluation tools, training staff).
The board (12 members) meets every month and has responsibility for budgets, human resources and ethical values policies. A solidarity committee deals with financial help for users with low income.
What are/were the effects?
Principle for internal assessment
There is a continuous evaluation process which is divided into several parts:
- External representative user survey.
- Internal analysis headed by an external expert for a year: monthly meetings of an internal pilot group (paid employees, volunteers, board members) to discuss work and user related items; to report on functioning or malfunctioning, and to suggest changes to be put in place.
- External observation study (working processes, internal communications, behaviour of the care call centre worker as listeners etc.); data analysis using documents, statistics, internal reports.
- Continous reporting to the board on any internal problems, staff policy, problems with individual users, and the neighbourhood committee; develop research for solutions, make decisions.
Results
In 2009, among the 112,020 overall calls received, 73% of the proportion that were from users were made during the day, while 46% of the emergency calls were made at night (8 pm to 8 am).
Fifity percent were not linked to specific issues but judged either as ‘unintended use’ (40%) or as symptom of an ‘implicit demand for social contact’. This was however frequently described by users as ‘technical checking of the device’. It show how users can use this device as a social link and preventative tool.
Regarding ‘urgent calls’, they were mainly linked to falls and anxiety during the day, and to respiratory problems that disorientated at night. Other frequent ‘emergency issues’ were pain, fever, feeling ill. Non emergency demands were linked to information, psychological stress (feeling alone), but also to a ‘conscious demand’ for social contacts or issues linked to fear of home burglary.
Response to client’s calls relating to specific issues resulted in 69,265 ‘monitoring calls’ performed by the call centre staff.
80% of the issues could be resolved by the local committee alone when triggered by the call centre. A committee member could be contacted on average after three phone calls and in less than two minutes.
In cases where extra (health) assistance was needed, it took about half an hour to resolve the issue, and for more ‘simple’ issues, this took about 10 minutes. The average length that users remained with the service was 3 years; withdrawal was due in the main to death and institutionalisation, and for a small amount of people (5%) this was due to dissatisfaction with the service. In fact 98% of users were satisfied or very satisfied.
What are the strengths and limitations?
Strengths
- The strong coupling of well trained staff managing a call centre with a strong link to a network of dedicated local neighbourhood committees enables the organisation to provide a quick and appropriate answer to user’s demands once an accurate diagnosis of the problem has been carried out. It leads to high achievement of goals and enables older more frail people to be maintained safely in their own homes.
- With the help of the local committees, call centre staff are able to resolve more than 80% of the issues linked to the call without extra intervention.
- By monitoring calls to patients more at risk of adverse events, and using smoke and falls detectors linked to the call centre, it is also a powerful preventative tool.
- In cases where more compex intervention are needed, users and the family are monitored until the end of the episode.
- Decentralisation and local partnerships with home care agencies permits interventions to be more flexible.
Limitations
- There are limitations in access because of a lack of public information due to limited geographical coverage; and in developing capacity because support from the majority of stakeholders working in the prevention field is low.
- The organisation suffers from lack of recognition of the high quality of the support provided and has not as yet received official acknowledgment. Therefore only a restorative use this service is entitled to public reimbursement through APA (attendance allowance); it’s use as a preventative measure cannot be reimbursed.
- There is unfair competition: There are higher organisation costs which are linked to the skills needed for the service to operate at a high level. As the organisation is not officially recognised, it is not able to differentiate itself from competitors whose provision may be low quality and the service is at risk of being driven out of the market.
Credits
Author: Michel NaiditchReviewer 1: Kai Leichsenring
Reviewer 2: Hannelore Jani
Verified by: Patrick Ryon, CEO Equinoxe; direction@equinoxe-France.com
