Case study: The Jack Dawe homecare team
The Jack Dawe specialist homecare team is a service that provides person-centred care packages to individuals with dementia within Nottingham City. Catherine Willetts is an Occupational Therapist working within the Jack Dawe team and involved in the assessment and implementation of low and high ‘tech’ assistive technology. She has provided the following examples to demonstrate some of the benefits and challenges that occur with the implementation of assistive technology and highlight the need for comprehensive assessment and evaluation.
Case study 1
Jack was an elderly gentleman with a diagnosis of dementia who had recently been bereaved from his wife. There were a number of reports from the neighbours that Jack was found outside during the day and evening in his pyjamas, disorientated and in need of reassurance. His daughter, who lived outside Nottingham, was visiting for an increased number of occasions during the week and was feeling increasingly distressed.
Assistive technology installed
Initially, large print visual signs were placed on the back of the front door informing Jack not to leave the house but to call his daughter or wait for the carers to visit. However, following assessment these signs were not found to be effective in preventing Jack from leaving his home as they would go unnoticed.
Jack was happy to consent to a trial of a wander ‘memo’ reminder because of the concerns raised by his daughter. A message was initially recorded with his daughter’s voice asking Jack to stay indoors and wait for the carers to arrive. Following assessment it was apparent this did not distress Jack who responded with a smile on each occasion this was activated.
The wander reminder was positioned at the front door and set on ‘Auto’ to action at all times of the day in order to prevent Jack from leaving his home. Homecare staff were able to check this on a daily basis and ensure it did not cause any detriment to Jack’s health.
Over the following weeks there were no reports from the neighbours that Jack had been seen wandering outside and this reduced anxiety levels for Jack’s daughter. The wander reminder remains in Jack’s home and the message is updated every 6 weeks to ensure it does not become too familiar. This piece of technology has been effective in the short term however will need reviewing at regular intervals to ensure that it is still meeting Jack’s needs.
Case study 2
Kate is a 62 year old lady who has early onset dementia. She is an extremely active lady who goes out on a number of occasions each day. She is disorientated to the day and time. Her family have significant concerns that Kate is leaving her home at night and reports from her neighbour confirm this. On occasions homecare arrive early in the morning and Kate is already out which means she can miss taking her medication and is skipping meals. A risk assessment highlighted an unknown prevalence of Kate leaving her home.
Assistive technology installed
A wander ‘memo’ reminder was trialled in an attempt to reduce Kate’s night time activity. This was recorded with a familiar voice which informed Kate it was night time and not to go out. This was programmed on a timer to be active between the hours of eight in the evening and eight in the morning.
It was agreed that ‘Just Checking’ motion detectors would be beneficial to track the level of activity in Kate’s home and evidence the frequency of her outdoor visits day and evening. Kate consented to this measure and these detectors were trialled for a month assessment period.
The wander reminder caused increased anxiety in Kate who continually turned off the device. Homecare workers tried to establish the reminder with Kate however she was unable to recall its purpose and threatened to throw it away. The wander reminder was removed once consent was questioned. This illustrates the need for continuous assessment and review.
The Just Checking activity monitors did not cause any anxiety to Kate once installed as the sensors are compact and do not sound alerts or alarms. Activity data was collected for a month. This information was used to arrange more effectively timed homecare visits. It also showed that Kate did not leave her home after four in the afternoon. This provided some level of reassurance to the family and enabled Kate to remain at home for several months before her situation deteriorated