Based on the 1999 ‘Royal Commission on Long Term Care’ report, the Alzheimer’s Society describe assistive technology as: “any device or system that allows an individual to perform a task that they would otherwise be unable to do or increases the ease and safety with which the task can be performed".

The types of assistive technology available to those living with dementia and other medical conditions are fairly wide ranging. They include: - smoke, fall and flood detectors, alarms and ‘telecare’ services. However, in this article we concern ourselves purely with the technology that helps reduce wandering and missing. These types of technology include:

Preventative:

• movement-activated voice alerts – infra red sensors that send a voice message to the person when activated e.g. “dad, don’t go out, it’s night time”.
• temperature sensors – sends a warning signal when the temperature in a room becomes too cold/hot (uncomfortable temperatures may be a reason a person becomes agitated and feels the need to leave and wander).
• specialist clocks – these place a strong emphasis on time/day/season (a confusion around time may be a reason a person becomes agitated/focused and feels the need to leave and wander).
• light boxes – devices that regulate or provide light (light stimulation/deprivation is another reason a person may wander).
• object locators- tags attached to everyday objects which emit and audible alarm when lost. Some systems are app based (some people wander because they perceive they have lost something and need to find the object).
• medication reminders - automatic pill dispensers that raises an alert to remind a person to take their medication.
• daily activity monitors and recorders – infra-red sensors oversee a person’s activity in their homes and feeds back data to help plan support. Can also be used to alert carers to a problem.

Warning Devices:

• door and window alarms.
• pressure pads and mats – can be placed under mats, beds and chairs to alert carers of movement/absences.
• motion sensors - sensors strategically placed (near a bed/chair etc.), which will identify when a person hasn’t returned within a set time and raises an alarm.
• mobile phones – with easy pre-programmed buttons, including a SOS button

Devices can be used to complement each other e.g. a pressure door mat may alert a carer to the opening of a front door but doesn’t confirm that they have definitely left. A motion sensor can detect if the person is still inside.

There is also a tendency to include within AT, remote monitoring services that are often referred to as “Telecare” * – Telephone Care. There are a number of careline companies who offer a range of support services through a remote contact centre. Effectively the careline company will remotely monitor the person in their home through sensors or detector devices that are linked through a base unit to the telephone line. When a specific problem is detected through the sensors e.g. a fall, smoke, gas, or water flooding, a signal is sent to the company who in turn request assistance with a pre-arranged point of contact - family member, carer, friend, neighbour, warden etc. The company can also contact emergency services if required and some services offer a talk through service to the person who is in difficulty.

Please note:  Telecare is the common term for these services. However, there is also a company called Telecare who offer careline services, and whom have adopted that commonly used term. They are just one of many companies offering this service. Safeguarding Hub does not endorse or recommend any one service or company.

Global Positioning System (GPS) is a satellite-based navigation system that was first developed for military purposes in the 1960’s and finally made available for public use in the 1980’s. GPS relies on a number of satellites circling the Earth to transmit signals back and forth to GPS devices, which when decoded reveals the devices exact location. The technology can also measure speed, distance travelled and distance to a pre-programmed coordinate. GPS tech is extremely accurate, working in city, rural and on water environments equally well. Most hi-tech GPS receivers are accurate to within 10 metres. In the last few years advances in technology have seen GPS enabled devices shrink in size and GPS is now included as a standard feature in all Smart phones. Mobile phone apps like ‘Lifestyle 360’ allow the user to invite family members to the location sharing group. The user can pre-programme certain venues (home, favourite store, school etc.) and receive notifications when a family member arrives and leaves those pre-programmed venues. It also offers a weekly driving summary for the user and those connected to the group.

The size of these GPS locators is important as it now enables a person to carry a small device on a person’s clothing or in their property with or without their knowledge, which enables others to track and locate them with ease.

So, what is available? Well there are various GPS trackers available in the market place, with a range of differing models, shapes, sizes, functions and cost. A general rule of thumb is that the cheaper the model, the shorter the battery life. Beware of the cheaper imports. A battery life that lasts less than a day is unlikely to be of any benefit. At the higher end of the price range are tracker services which are a managed service, requiring a contract and a monthly fee. If you are a carer, family member or professional looking at purchasing a tracker, then our advice is to shop around and get some advice. Do your research, look at what tracker is right for the person and ask yourself the question - what do I want it to do. Ensure that it is always sourced from a creditable supplier.

Some things to consider:

• a good battery life – some devices have a battery life of 30 days.
• shape and size – where is the person going to carry it? Does it need to be attached to them? Are they likely to remove it? Does it need to be covertly concealed in their clothing?
• cost – prices range from a one-off payment of £10 to several hundred pounds when using the tracking services of a specialist company. You get what you pay for but shop around.
• functions – what can it do? Whilst most come with the basics functions, location, speed, route history, others have specialist functions. These can include: remote monitoring (allows a carer to call and listen to what is going on around the device), SOS function, geo-fence boundary facility which allows a carer to set a safe perimeter before the tracker is activated, 2-way communication allowing carer and person to communicate with each other.

Various types of tracker technology include:

• GPS enabled Smart Phones.
• Bluetooth – not GPS, but trackers that operate through Bluetooth on a person’s smartphone.
• Smart Sole – a tracker that can be placed in the sole of shoe.
• Personal GPS locators – trackers that come in a variety of designs and not monitored by a 3^rd party company.
• Monitored – GPS trackers that are monitored by a call centre.
• Geo-fence trackers – trackers that allows boundaries to be set. Provides an early warning when the boundary is passed.
• Pebble style mini GPS Tracker with SOS alarm.

GPS Terminology

SOS function – many trackers have a SOS button which when activated will emit an automatic message showing the current location of the tracker to any devices that have been pre-programmed to receive the alert.

Live Tracking – this means that a person can monitor, locate and track another person on-screen using either an app or website.

Geo-fence function – this is software that allows the carer to set a virtual geographical boundary on a map screen, using GPS or RFID (radio transmission) tech. Carers can create zones which when crossed sends a warning message, alerting the carer to the fact that the person has left the set area.  Some systems allow different zones to be set at varying days or hours in a day dependent on the persons lifestyle.

Warning: It is important to note that the tracker or device needs to be turned or enabled on for GPS tracking to work.

AT – There is little doubt that AT improves healthcare. When tailored to an individual’s needs it can improve quality of life and extend independent living. Dependent on the AT used, it can also reduce the stress and anxiety of families and loved ones, providing them with some reassurance and the peace of mind that there are measures in place to limit risk, and assistance can be summonsed if necessary.

GPS - allows law enforcement and search agencies to track and locate a vulnerable missing person quickly and safely. Like AT, GPS can give families and carers some reassurance that they have done their best to maximise the chances of their loved one  being found safe and well. It allows a person to go out independently, with the knowledge that if they get lost or feel unwell, they can either summons assistance (dependent on the device) or they will be found quickly.

Both AT and GPS can have the positive effect of increasing a person’s confidence and self-esteem by promoting a feeling that they are both safe in their home and when they leave it. Both technologies may contribute to a person’s ability to continue to lead a normal life.

AT - We have heard arguments that assistive technology can be misused or abused. Yes, they can, but so can physical and personal care. There are well documented and very recent cases of carer abuse both in the home and in a care setting. There will always be the opportunity for bad and cruel people to take advantage of vulnerable people. However, we are not yet at the age of the Cyborg where machines come alive and take over the world. The technology is not the villain of the piece. When assistive technology is misused or abused, a person will be responsible.

Can the technology fail? Yes of course it can, but a good risk assessment should be based on what can go wrong and what is the contingency plan when it does. There is also the possibility that personal data contained on software may be compromised. Again, yes this is possible, but is it much different from misplacing or losing a patient notes or a cyber-attack on the NHS where millions of people’s data is compromised? Are those who put forward making excuses and scaremongering just a little?

There is also an argument that an overreliance on AT could see a fall in carers within care and nursing homes. That is possible, but the grim reality is that the predicted figure of those who will be affected by dementia is likely to be 1 million people by 2021 (Alzheimer’s Society). We may be struggling for care providers by that stage, so isn’t it incumbent on us to explore and embrace innovative technology, which may assist carers in providing superior quality care. We don’t want to imply that AT shouldn’t be approached without caution, but not to approach and consider its benefits at all, is in our view fairly narrowminded.

What we are absolutely sure of, is that AT should not be a replacement for proper care. It should complement and support a person’s personal care plan. A very real concern is that it might reduce a person’s human contact, particularly if care line services are used routinely. A voice at the end of the phone doesn’t necessarily mean that a person has ‘contact’. A person can quickly feel isolated and lonely, countering the very reasons why the AT was introduced in the first place. A healthy balance has to be struck.

GPS – in our view the disadvantages for GPS differ slightly from AT. In our jobs as missing person advisors, we are very biased when we say that there are very few drawbacks in being able to find a vulnerable missing person quickly and safely. Assuming that the person is willing to wear the tracker, then one potential disadvantage is that it may give that person a false sense of security, an overconfidence to go to places where they might otherwise get into difficulty. Another issue concerns false alarms when using geo-fence type devices. Multiple false alarms may lead to distrust in the system and may well lead to a ‘cry wolf’ scenario. Of course, this all assumes that the person who is using the GPS or AT is aware of it and agrees its use. What if they don’t know, or are aware but are not happy about it which leads us on to whether the use of GPS and AT is morally right?

We have read some pretty extreme views around whether AT and GPS technology for people with dementia is ethical. Some have even gone as far as suggesting that placing a tracker on someone is the same as tagging an animal. The use of geo-fence function produces criticism that rather than generating a virtual safe haven, it creates a virtual prison.  Commonly cited reasons are that AT breaches a person’s civil liberties, their right to lead a private life, leads to a loss of dignity and causes them to be stigmatised. These are pretty damming indictments on technological devices that are meant to help and safeguard people. We think that these issues can be put into 3 categories – 1) those that are able to consent and do, 2) those that are able to consent but refuse, 3) those that are unable to consent. Here is our view:

Those that are able to consent and do - Where a person has the capacity to consent and can provide an informed decision, then quite simply it is job done. The dictionary definition of informed consent is: “permission granted in full knowledge of  the possible consequences, typically that which is given by a patient to a doctor for treatment with knowledge of the possible risks and benefits”. Whilst the examples cited in dictionaries generally relate to the doctor/patient relationship, we believe that the principles are sound for AT and GPS. However, as a safeguarding professional it is important that you explain to the person carefully and in detail, what the AT or GPS device is, what it does and how you think it will enhance their life and safeguarding. Any concerns a person might have should be addressed and any opinion put forward should be balanced and, in the persons, best interest. If the person has been provided with the fullest appropriate information, including any potential risks, benefits and consequences, then any consent they give, has to be considered sound.

Those that are able to consent but refuse - This scenario is not overcomplicated either. If a person has capacity to consent and refuses to have AT or GPS technology assist them, then that is pretty much it. The rule is that mental capacity is presumed unless it is proved otherwise. The Mental Capacity Act 2005 covers a person’s inability to make informed decisions. The bar to  prove that someone does not have the capacity to make their own decisions is set fairly high and factors that have to be taken into consideration include: are they able to understand the information relevant to the decision; are they able to retain that information and can they weigh up that information as part of the process of making a decision?

The act even covers the fact that “a person is not to be treated as unable to make a decision merely because he/she makes an unwise decision”. This means that where a person can make an informed decision there should be no attempt to force AT or GPS onto them and certainly any form of covert monitoring or surveillance may well be unlawful. Clearly any identified risk will still need to be managed and there is nothing to prevent professionals, carers or family from periodically revisiting the subject with the individual involved. Part of the ongoing risk assessment should also consider whether that ability to make informed decisions for themselves is still sound, or whether they now no longer have that capacity.

Those that are unable to consent - This is where the issues become much more complex. If the person no longer has capacity to consent and there is a Power of Attorney in place, then the person who holds that PoA is under a duty to act in the persons best interest. This would include the introduction of GPS and AT if the circumstances warranted it. It has to be the persons best interests and not just because AT would make life easier for the carer. The question will be - is it necessary, proportionate and genuinely in their best interests? If the answer to this is yes, then it will be the right thing to do. Where there is no Power of Attorney then professionals will often be guided by the wishes of the family. However, as professionals it is our duty to guide the family, so they can make the right decision for their loved one. We can do this by a thoroughly examining the current (and potential future) risk, to provide families with the fullest information to enable them to decide wisely. Where there is no family or interested party, then professionals should make a ‘best interests’ assessment.