Part one: analyse your local themes

Whilst the impact of COVID-19 on adult social care provision is dynamic and often localised, clear common issues and challenges have emerged through our engagement.


There is a strong focus on the impact on older people – due to the increased likelihood of requiring care and support. However, challenges are impacting all adult social care service users and carers including learning disabilities, autism, mental health, people with sensory impairments and people with physical disabilities. The challenges, causes, impact and how these are potentially being addressed are outlined below.

Reduced care capacity

Underlying causes

  • services closed due to COVID-19 restrictions eg day care provision, voluntary sector support offers
  • implementation of care act easements to enable councils to manage pressures extreme new pressures
  • social, support and communication activities (statutory and non-statutory) not operating
  • supported living and shared accommodation schemes are having to limit contact between residents due to social distancing / isolation / shielding guidance
  • care workforce isolation / shielding or sickness leading to reduced offers

Impact

  • reduced social contact and stimulation – mental, physical and wellbeing
  • potential impact on income if users are unable to work eg adults with a learning disability or autism
  • wellbeing and isolation impacts
  • reduced respite for unpaid carers
  • increased pressure on unpaid carers – possible impact on wellbeing and resilience 
  • service users refusing / declining services due to fear of increased risk of infection

Technology enabled approaches

  • consider alternatives to building-based, face to face delivery eg virtual methods for maintaining contact and delivering activities
  • support family members to deliver interventions and activities
  • increase monitoring and checking activity for service users and carers
  • use technology to connect service users to each other to sustain social contact
  • use technology to connect carers to each other for peer support and advice

Potential care technology response

  • video-based day care provision through tablets, laptops or other smart devices. Blended approach to consumer technology and adapted technology depending on availability of technology and technology skills (consider adapted technology for those who are digitally excluded). Multiple examples of councils and providers using consumer technology – particularly with learning disability clients to maintain interaction with services and each other
  • increased / proactive use of telecare services to check-in and monitor people
  • increased use of remote monitoring devices
  • voice-based solutions
Hospital discharge

Underlying causes

  • hospital discharge and maintaining flow is pressured in some areas
  • COVID-19 discharges presenting new challenges for reablement / enablement providers and care providers (people who are discharged whilst still symptomatic and / or potentially infectious)
  • lack of appropriate PPE 
  • people who would normally receive reablement / enablement support are declining through fear of infection risk and / or because eligibility thresholds have changed

Impact

  • potential delays to hospital discharge having a knock-on impact on bed availability for others
  • people unable to return home with support in a timely way. Risks deterioration in function, increases likelihood of need for on-going care and support. Increased risk of cross-infection in hospital setting
  • people being discharged home without appropriate care and support in place / reablement support
  • risks long-term deterioration in function and reduced independence. Long-term impact on increasing demand for social care

Technology enabled approaches

  • consider alternatives to hands-on care, support and reablement eg virtual methods for delivering care
  • support family members already in contact to deliver care and support
  • increase monitoring and checking activity
  • support self-management approaches through provision of advice, guidance, training and coaching

Potential care technology response

  • video-based care delivery through tablets or other smart devices
  • use of apps and on-line training to support families to deliver and support reablement activity
  • increased use of remote monitoring devices and issuing equipment directly from hospital sites to speed up deployment and reduce infection risk from home-based installation. Products such as community alarms, falls detectors, and specific communication tools adapted for discharge
  • increased / proactive use of telecare services to check-in and monitor people
  • voice-based solutions
COVID-19 hotspots, eg care homes

Underlying causes

  • the reality of the challenge of communal living with high risk people, how to maintain a safe, comfortable setting whilst also complying with infection prevention guidance
  • higher risk setting for transmission of infection due to the need to interact with health professionals
  • not practical to effectively shield people in these settings due to need and staff rostering
  • challenge of isolating residents in their accommodation
  • lack of appropriate PPE
  • Movement of residents from and to hospital

Impact

  • increased risk of contracting COVID-19 for residents and staff
  • wellbeing and emotional impacts as a result of isolation and disruption to social / communal activities, and restrictions on access for friends and family members. Both for residents who are well and for those who aren’t
  • decreases in function and capability – particularly in dementia residents and people with a learning disability in supported living or extra care settings
  • increases in challenging behaviour for some residents due to lack of social contact and disruption to routine

Technology enabled approaches

  • consider use of monitoring devices to support people to remain safely in their own accommodation
  • use of communication devices to support hands free communication within the care setting and with friends, families and professionals outside the home
  • increase monitoring and checking activity

Potential care technology response

  • video-based care delivery through tablets or other smart devices
  • contactless delivery of plug & play technology provides alternatives to installations either where service user doesn’t want contact or there is a shortage of PPE
  • use of consumer technology to enable video contact with friends and family
  • use of care technology devices eg falls pendants, pressure pads and movement sensors to monitor residents’ activities in their own accommodation – either from within the scheme / home or remotely
  • increased use of remote monitoring devices and digital care home solutions

NB: telemedicine and remote consultation is out of scope, but could hugely benefit unwell residents in these settings and maintain effective remote contact with health professionals

Telecare continuity

Underlying causes

  • workforce availability in monitoring centres, responder services and care technology teams
  • ability to deliver and install care technology in a way that is compliant with social distancing / isolation / shielding guidance
  • challenges with supply of device and hardware

Impact

  • care technology not available to new users at a time when its use could significantly enhance independence, safety and wellbeing
  • ability to maintain monitoring and response services through the COVID-19 period

Technology enabled approaches

  • maintain infrastructure and supply to ramp up activity, not reduce it, to support vulnerable residents / service users
  • consider extending catalogue in response to emerging needs / issues
  • use technology to enable call centre workers to work remotely when they are self-isolating / shielding

Potential care technology response

  • increase roll-out of telecare services to a broader range of users – linked to COVID-19 status
  • proactive use of telecare call centres to reach out to vulnerable residents underway in a number of areas
Focus on recovery: concern about the long-term impact of COVID-19 on already vulnerable people – how this can be mitigated now and how can recovery begin to happen

Underlying causes

  • detrimental impact of long-term social isolation on mental health, wellbeing, social skills and function due to compliance with infection prevention measures. Particularly impactful on people who are already vulnerable and with existing mental health, emotional or wellbeing issues

Impact

  • outcomes leading to increased demand for care, support and health services

Technology enabled approaches

  • consider providing hardware and software to promote contact and for communication and wellbeing
  • extend use of befriending / social isolation services over digital channels to those who are self-isolating or shielding and living alone, to those who are known to be vulnerable, and to carers

Potential care technology response

  • deployment of consumer technology and/or adapted devices to enable people to maintain contact with friends, family or services
  • consider apps to promote mental and physical wellbeing to vulnerable users
Digital exclusion of vulnerable residents / service users and, occasionally, care workers

Underlying causes

  • the most vulnerable and excluded may not have access to consumer technology which is being used by many to maintain contact and daily living
  • connectivity challenges particularly in rural areas
  • cost, knowledge and skills are common barriers

Impact

  • increased impact of isolation on vulnerable adults leading to increased demand for care, support and health services

Technology enabled approaches

  • consider the deployment of connectivity; adapted technology / consumer devices to people who are commonly digitally excluded
  • consider the use of adapted devices / technology for older people, people with dementia and adults with a learning disability or autism to ensure they can participate in digital activities

Potential care technology response

  • adapted tablets
  • assistive technology communication aids targeted at specific user cohorts / needs eg sensory impairments
  • connectivity: sim cards and broadband
Impact on carers

Underlying causes

  • closure of key services such as day care and support groups which provide respite and support for unpaid carers  
  • increased caring responsibilities due to a reduction of availability of care for loved ones and / or to support loved ones to remain isolated, shielded and increase protection from infection.

Impact

  • increased pressure on unpaid carers can lead to a deterioration in their own health, wellbeing, resilience and ability to cope
  • longer term impact on demand for health and care services either through increased need of carers and / or people no longer able to sustain their caring responsibilities

Technology enabled approaches

  • deploy technology to maintain contact and support for carers with friends, family or services – consider extending support for carers
  • deploy technology with loved ones to provide social support and contact
  • support carers / family members to deliver interventions and activities
  • increase monitoring and checking activity for service users and carers
  • use technology to connect service users to each other to sustain social contact
  • use technology to connect carers to each other for peer support and advice

Potential care technology response

  • video-based contact through tablets, laptops or other smart devices. Blended approach to consumer technology and adapted technology depending on availability of technology and technology skills (consider adapted technology for those who are digitally excluded)
  • increased / proactive use of telecare services to check-in and monitor people
  • increased use of remote monitoring devices
  • voice-based solutions

Alongside these specific adult social care challenges, teams are also dealing with the challenges of remote working, linking effectively into community responses, partnership working and effectively communicating with a range of stakeholders.

This guide has been developed by the Care and Health Improvement Programme in partnership with RETHINK Partners to support adult social care teams who are seeking to use and deploy care technology – fast – as part of their COVID-19 response.

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