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Just Checking

Summary

Description

Operational Information

Evaluation

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Summary

Just Checking (JC) is an electronic monitoring system requiring no active input from the cared for elderly person being monitored, with small, wireless sensors located in the main rooms of the house which are triggered as a person moves around; data from the sensors are gathered by the controller (a small box), and sent to the Just Checking web-server via a mobile phone which is incorporated in the controller, so that informal and formal carers can monitor the information.

The service mainly reaches three kinds of users: old people affected by any form of dementia, family carers and formal carers. On the whole, the system is bought and used for assessment by a local authority or NHS trust, and family members are given log-in authorisation to use the system, too. Some family users then buy or rent the system for on-going use. This group tends to be in their 50s or 60s, technologically adept (including Internet use), and often still in paid employment (although sometimes only part-time).

The JC system is highly active, with around 1000 log-ins (clients viewing activity data) a day. This is a large user group, though it is observed that there are up to 270,000 people with dementia who live alone in the community with family carers and professional care staff around them.

Professional users utilise JC for short term assessments of typically 3-6 weeks, to make adjustments to care plans, and then move the system to the next client. Family users usually have the system for around 18 months, and give it up when the person with dementia dies or moves to residential care if they have deteriorated to a point where they can no longer manage at home. The length of time family users make use of the system is potentially much longer if they are introduced to it earlier, but usually they are introduced to it at the point at which statutory services have already become involved.

At the micro social level, JC offers flexibility for carers, ‘peace of mind’ and the possibility to pursue recreational and occupational activities, and also facilitates care assessments. JC offers the informal and formal carers the possibility of controlling the care recipients and indirectly at distance and it allows the planning of care. It can also improve formal carers procedures. At the meso and macro levels the JC system can save costs for residential home admissions, because it is an alternative solution to residential/nursing care by monitoring risk and activating support when needed.

After public funding for start-up and implementation, the service is now self-funded.

The system is easy to use and install requiring only basic Internet skills and a mobile phone network and its costs between £500 and £1000 for the equipment and involves a weekly subscription of approximately £ 7. The system can be hired at approximately £70 per month.

The JC Team involves health and social care professionals and different organizations belonging to Social and Health Public Sector: the JC system is now being used for the assessment and care of people with dementia by more than 75% of UK local authorities, as well as by NHS trusts and major care providers.

Description
refers to the target users, kind of service provided, ICTs typologies and devices used

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Just Checking
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UK
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01-02-2004
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The first aim of the initiative is to help people in the early stages of dementia to continue to be independent and help formal and informal carers to manage care tasks allowing them to maintain peace of mind.

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Just Checking was developed as a result of talking to the families of people with dementia who told how much they worry about their relative who lives alone. To help families to face this difficult and stressful situation, in 2004 JC holders developed and piloted this innovative system with several UK social services authorities thanks to a UK government grant. Now 80% of UK local authorities use Just Checking for assessment and care planning and thousands of professionals and family users log on each day. The company is independently owned by its management team. The service believes that it is important to help people who are in the early stages of dementia to continue to be independent, and enjoy life trying to focus on what the person can still do and encouraging them to help themselves with prompts and reminders. As a result Just Checking aims to give informal carers a clearer indication of how the person being cared for is managing when alone in the house and help them decide whether they need more help.

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Yes Care Recipients
Yes Informal carers
Yes Paid assistants
Yes Formal carers

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Yes Independent Living
No Information and learning for carers
Yes Personal Support and Social Integration for carer
Yes Care coordination

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Just Checking Carer is the simplest Just Checking system, for families to keep an eye on a family member who lives alone.

Just Checking Professional is a portable kit used for assessment and care planning, by health and social care practitioners.

The service can also help with adults with learning difficulties.

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Kind of technological supports used by carers and/or care recipients:

  1. small wireless sensor;
  2. control box;
  3. mobile phone incorporated in the control box.

Operational Information
refers to the type of funding, budget, sustainability and organisations involved

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Both public and private
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Public service funding: Government, Regional, Local Authorities, non-profit public entities
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Not available

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Private out of pocket: users pay the service by themselves
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Not available

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Just Checking strategy is aimed at improving the targeting and allocation of care inputs for people still in their own homes, ensuring that these are geared more closely to need. All things being equal, reliable targeting of needs is a key element in delivering cost-efficient services to give more opportunities to support people in their own home, where they usually want to be in a cost effective way. The familiarity of home helps people with dementia to make sense of their world, and provides clues and reminders of what to do.

JC is a commercial business, funded by the owners since its inception. The majority of the business’s clients are currently local authorities with social services responsibilities (who have a statutory responsible for care assessment), Pregnancy Child Tracking (PCT) and mental health trusts, that sign up for 1 year or 3 year contracts.

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The business is now self-sustaining: the owner said that the sustainability of the business will depend on appropriate management of the business during the growth of the project but, in the future, ICT will have a major role in the social and health care system.

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Not available

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Yes Authorities
Yes Private Care Sector
Yes Health and Social Care Systems
No Third Sector
Yes Private Companies

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Not available

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Third Sector not involved
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No Informal Carers
Yes Health Professionals
Yes Social Care Professionals
Yes Privately-Hired Care Assistants (inc. Migrant Care Workers)
No Volunteers

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Just Checking employs 15 people, all who are permanently employed and most of whom work full-time. Among the business’s staff are the co-directors/co-founders, a customer support team (four people), and a small group of Occupational Therapists.

In February 2013 a National Commissioning Manager was hired for managing the company’s team of Occupational Therapists.

There is also an Assistive Technology Team.

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There are no voluntary workers currently affiliated to the business.

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1,001 - 5,000
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Not available information

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The main channel used to reach target user is the website and the word of mouth.

Evaluation
refers to the impact of the service on end-users, care organisations and authorities

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The service positively impacts on:

- Informal carers, because it reconciles care and work, improves their social life and health.

- Paid assistants, because it improves their social life and health.

- Elderly people, especially in case of people with dementia living alone, because it help them to live safety in their own homes and improves their health and social relationships. JC has been shown to improve the quality of assessment of the cared for one’s needs and so the outcomes to fulfil them.

Other benefits: the acceptability of the ICT. From the positive assessment the increased use of the technology has emerged (Schneider et al., 2010).

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The service positively impacts on:

- Private organisations that provide care by making cost savings and optimizing resources. The overall programme has proved to be cost effective. These outcomes are achieved at a relatively low cost per case.

- Companies and labour market, because the service helps the informal carer to reconcile paid work and caring tasks and it avoids added costs for replacing the worker who has to stay at home with the care recipient (Schneider et al., 2010).

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This service helps to reduce the costs of home caring and hospitalisation. Moreover, the service helps to optimise financial and human resources. In the case of elderly people who are cognitively impaired and living alone, Just Checking offers support for informal carers and can assist formal carers in planning their inputs leading to greater confidence and more sustainable care packages. Just Checking can offer an alternative solution to residential/nursing care by monitoring risk and activating support when needed (Schneider et al., 2010).

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The SWOT analysis is based on different evaluation studies carried in Warwickshire, Herefordshire, Staffordshire, Leeds and Nottinghamshire (see References) by public organizations independent for JC.

Strengths:

  1. The service provides objective, reliable and continuous information about the movements of people who are unable to give an account themselves. It is relatively unobtrusive, consisting of a control box which requires a power supply and wireless sensors which can be mounted in any room. With increasing experience of Just Checking, confidence in the data interpretation increased. It was felt to be very good in terms of picking up on absence from the home and patterns of movement within the home. There is evidence that the use of the Just Checking system avoids the premature admission of elderly to hospital and residential home.
  2. There are a range of combination and packages, tailor made to suit the service users’ needs.
  3. Initial wariness was largely overcome by the training, information and support provided with JC by the Assistive Technology team. Once Just Checking provided useful data for care planning, reservations were put aside and the data convinced people of the usefulness of JC.
  4. Just Checking can offer an alternative solution to residential/nursing care by monitoring risk and activating support when needed (Department of Health, 2008).
  5. JC's use can reduce the number of unnecessary home visits by health professionals (nurses and practitioners) (Warwickshire County Council et al., 2006)
  6. Many different Awards were received by Just Checking:
  7. At the 2012 Birmingham Post Business Awards, Just Checking won ‘Best Small Business.’
  8. 2010 Just Checking won a Technology Strategy Board competition to develop Just Checking for innovative night services for people with dementia.
  9. 2009 NHS Health and Social Care Awards – our clients, Herefordshire County Council and Herefordshire PCT reached the regional final with their clever use of Just Checking in their mental health intermediate care service.
  10. 2008 Just Checking was highly commended in the UK eWell-Being Awards. The Independent newspaper’s National E-Well Being Awards supplement.

Weaknesses:

  1. Risk of misinterpretation of the signals
  2. It has proved more difficult to interpret the data where someone was very active.
  3. As the cost of renting the Just Checking system is approximately £70 a month, it is thought that this probably puts people with relatively low income levels off .
  4. There is a need for a central data repository with dedicated staff time. Staff with experience of dementia who used JC felt that they could interpret the data satisfactorily but staff who are less skilled in dementia care would require greater support.
  5. Several carers felt that it would have been helpful to have had JC at an earlier stage in their relative’s illness; they had been struggling for some time before it was suggested.
  6. Key workers said to have checked the data daily when it was first installed, but less regularly thereafter, although practice varied. All highlighted the inappropriateness of JC being used as an alert system, unless other systems were in place to respond.
  7. Some formal carers felt that more than one of them should be looking at the data to aid interpretation but also raised the question of who should have access to it. There was also a question about data overload if the number of systems in use increased greatly. All formal carers were concerned about the way that data could be misinterpreted. For example it might show that someone was accessing the kitchen or bathroom but this did not necessarily mean that they were eating, drinking or managing their personal care. Equally, if Just Checking showed someone leaving the house, this would not necessarily mean that it is ‘risky’ behaviour.

Opportunities (University of Nottingham/Nottinghamshire County Council, 2010):

  1. Training: the initiative gives the opportunity to be trained on the ethical and mental capacity issues, to the staff members with little experience in dementia care using Just Checking even occasionally.
  2. Installation period: a maximum installation period of four weeks might allay concerns about the intrusive nature of protracted ‘monitoring’. This could be reduced as more staff gain experience of using the equipment.
  3. Timing: the service gives the opportunity to be used after an individual loses capacity and before residential care appears inevitable. Just Checking could be presented more accurately to improve assessments of need while a person is still at home.
  4. Potential for intervention: there is the possibility of using Just Checking or other similar equipment in real time to intervene. As the use of telecare becomes more common and acceptable, and as technology develops, the potential for remote interventions will increase. It will be discussed about the circumstances in which it might be in a person’s best interests to permit access to more information, including visual and audio monitoring, and to utilize this to intervene remotely.

Threats/challenges of the service:

  1. Some formal workers noted that it might have been helpful to use Just Checking at an earlier stage in the assessment and care planning process, although current guidance suggests that Just Checking should be considered only after all other options have been explored. One formal carer interviewed had attempted to use it with three clients, each of whom deteriorated so soon afterwards that the monitoring could not be completed. Timing of the installation emerged as an area of considerable uncertainty, so the company needs to gain more experience with JC before it is possible to develop guidance on when JC can be most useful.
  2. Ongoing concerns about ethical issues may have had an impact on some formal carers’ attitudes towards using the system. These concerns include fears that Just Checking might be taken up by families to monitor their relative, which was seen as inappropriate. This is a contested point, since one example of such monitoring clearly gave the relatives greater peace of mind. In that instance, a service user was going to bed early, so the relative used JC to monitor her movements in real time and ring to remind her what time of day it was. This highlights the potential for JC to trigger interventions, an application which was not utilised by the formal carers interviewed.
  3. Access to data as there is a discussion around who in staff teams should have access to the Just Checking data, and whether families should always be given the option of accessing the data. A policy on staff and family carer access to JC data seems to be needed.
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A development that is already underway with a roll-out to a number of English councils and an adaptation of the equipment to be used with adults with learning difficulties requires a larger operating system. Councils are keen on reducing costs involved with adults with learning difficulties so this has been a good market. The web service has been expanded, allowing more people to be supported by Just Checking. It is hoped the system can be transferred across national boundaries soon, as its web-based operating system is user-friendly and can be accessed all over the world

More Information
includes contacts, publications and accompanying documents

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Nottinghamshire Evaluation of Just

References:

Checking Telecare System

Schneider J., Read D., Rhodes B. (2010) Nottinghamshire evaluation of Just Checking Telecare System, at http://www.justchecking.co.uk/downloads/pdfs/Nottinghamshire_jc_evaluation_report_march_2010.pdf

Publications:

Department of Health (2008). Assistive technology. Efficiency delivery: supporting sustainable transformation. Evaluation of Just Checking. Department of Health, available on http://www.justchecking.co.uk/cms-assets/documents/Case%20studies/17367-519621.staffordshireatcasestudy.pdf (last access: June 2013 ).

Herefordshire County Council & Primary Care Trust (2009). Reducing admissions to residential care. Mental health intermediate care. Herefordshire County Council, available on http://www.justchecking.co.uk/downloads/pdfs/XXXjust-cheking-herefordshire-leaflet%20.pdf (last access: June 2013).

Leeds Partnerships NHS Trust (2009). Just Checking 1 Year Pilot Report - Giving People with Dementia a Voice. Leeds: Leeds Partnerships NHS Trust, available on http://www.justchecking.co.uk/downloads/pdfs/leeds_report.pdf (last access: June 2013).

University of Nottingham & Nottinghamshire County Council (2010). Nottinghamshire evaluation of Just Checking Telecare System. Nottingham: University of Nottingham, http://www.justchecking.co.uk/downloads/pdfs/Nottinghamshire_jc_evaluation_report_march_2010.pdf (last access: June 2013).

Warwickshire County Council (2006). An evaluation of the Just Checking telecare system for people with dementia.

Warwickshire County Council, http://www.justchecking.co.uk/downloads/pdfs/trial_results.pdf (last access: June 2013).

Newhaven Research- The Telecare Development Programme in Scotland 2006-11, July 2011

Dept of Health – Living well with dementia: A National Dementia Strategy- Good Practice Compendium- an assets approach, January 2011

University of Nottingham/Nottinghamshire County Council - Nottinghamshire evaluation of Just Checking Telecare System, March 2010

The Dementia Services Development Centre, University of Stirling- Telecare and Dementia, 2010 (excerpt only, full text available at http://www.jitscotland.org.uk/publications-1/telecare/)

Dept of Health – Use of Resources in Adult Social Care- A guide for local authorities, October 2009

Leeds Partnerships NHS Trust (mental health trust) – Just Checking 1 Year Pilot Report – Giving People with Dementia a Voice, June 2009

Herefordshire County Council and PCT - Evaluation of mental health intermediate care service, March 2009

Dept of Health – Staffordshire County Council – Evaluation of Just Checking as an assessment tool in Staffordshire, December 2008, Learning disability services:

Wolverhampton City Council- Demonstrating how the use of technology can support or increase independence for individuals and their carers within supported living accommodation, August 2012

Dorset County Council- Just Checking in Learning Disabilities Services : 1 Year On, May 2012

Lang & Buisson commissioned by Dept of Health- Illustrative Cost Models in Learning Disabilities Social Care Provision, May 2011

The Dementia Services Development Centre, University of Stirling- Telecare and Learning Disability, 2010 (excerpt only, full text available at http://www.jitscotland.org.uk/publications-1/telecare/)

Dept of Health – Cheshire East Council – Evaluation of use of assistive technology for adults with learning disability in Cheshire East, December 2008

Warwickshire County Council Evaluation of the Just Checking telecare system for people with dementia, April 2006.

 

 

 

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Telephone number:

Telephone number: 0044 01564 785100

E-mail link: http://www.justchecking.co.uk/families/contact-just-checking/

Just Checking Ltd

The Mill, Brome Hall Lane

Lapworth, Warwickshire, B94 5RB