Guide Telecare and telehealth: what it is and how to get it

Transcription

Guide
Guide 6
Telecare and telehealth: what
it is and how to get it
Telecare and telehealth is technology that can be used to help you live safely
and independently in your own home. This guide covers the different types
of telecare and telehealth, how to get it, and how to decide if it is right for
you.
The Independent Age advice service offers free information and advice
on issues affecting older people. All the guides we publish are available
from our website www.independentage.org and paper versions can be
ordered by calling 020 7241 8522.
You can also call our advice line on 0845 262 1863 to arrange an
appointment to speak to one of our experienced advisers.
Independent Age is a unique and growing charity providing information,
advice and support for thousands of older people across the UK and the
Republic of Ireland.
There are differences in the ways each country cares for and supports older
people. The information in this guide applies essentially to England, although
there may be similarities with countries in the rest of the UK.
We also produce five separate guides for both Scotland and Wales covering
the needs assessment process; paying care home fees and making a formal
complaint, which are the key areas where the policy and legislation differs
significantly from England.
All of the guides we publish may be downloaded from independentage.org or
posted to you if you call our guide order line on 020 7241 8522.
This guide was last updated in June 2013.
Guide 6: Telecare and telehealth: what it is and how to get it
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Contents
1. What is telecare?.............................................................. 5
2. Types of telecare.............................................................. 5
Movement detectors..........................................................
6
Alarms.............................................................................
6
Sensors............................................................................
6
Reminders.........................................................................
7
Sensory impairment alarms.................................................. 7
Carer’s alerts...................................................................... 7
Location sensors................................................................. 8
Activity monitoring – telecare and non-telecare systems........... 8
3. When to use telecare......................................................... 9
Is telecare appropriate for you?............................................. 9
4. How can I get telecare?..................................................... 11
What if the telecare package offered is too limited?.................. 12
What to do if you want to complain........................................ 12
Will telecare affect my existing package of home care services?.. 12
How much does telecare cost?............................................... 14
Can I get telecare privately?.................................................. 15
Does the condition of my home affect my ability to use telecare? 15
5. Examples of how telecare can be helpful or unhelpful........ 16
Supporting independence...................................................... 16
Reducing independence........................................................ 17
Supporting mobility.............................................................. 18
Supporting carers................................................................. 19
Supporting people with dementia........................................... 21
6. Care homes and telecare................................................... 22
7. What is telehealth and how do I apply for it?.................... 23
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8. Things to consider............................................................. 24
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1
What is telecare?
Telecare means using technology to support people in need of care or
assistance. For example, you may be familiar with community alarms worn
as a pendant or the pull cord alarms, often found in sheltered
accommodation and accessible toilets. This is telecare equipment.
Telecare sensors have now also been developed to detect other problems.
For example, sensors can be used to detect if you have not moved for some
time, if you have left a tap running or left the gas on. The telecare sensors
will then alert you, your carer or a response centre, to the problem.
Most systems use a telecare control box connected to your telephone line,
which connects you to a response centre, although some systems also
require an internet connection. If you trigger an alarm or sensor, a member
of staff from the response centre will call you back to see if you are alright.
You do not have to pick up your phone, as you will be able to hear the
member of staff through a loudspeaker on the telecare control box. If you do
not respond, the member of staff will contact someone you have identified to
help, such as your carer, neighbour, or another support staff member. They
will come out and see if you are alright, or call the emergency services if
needed.
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2
Types of telecare
The different types of sensors and detectors are listed below.
Movement detectors
If you are prone to falls or experience confusion, sensors can monitor your
movements. They can also detect if you are in or out of your bed or chair,
how much movement there is in a room, or when you are leaving a building.
Pressure mats can be placed beside beds, to detect if you have fallen down
or fall detectors can be worn on your clothes during the day. Sensors can
also be linked to other electrical equipment in the house, such as bed
occupancy sensors that link to the light switch when you get out of bed, or
to the bathroom light switch so you are not struggling to find your way in
the dark.
Alarms
Alarm buttons or cords can be placed around your home, so that they are
easily accessible if you need to call for help, and you can also wear a
personal alarm as a watch or pendant. Alarm systems can even be used to
provide support against bogus callers or intruders.
Sensors
Sensor can detect problems such as: gas, if a cooker has been left on unlit;
water, if a tap has been left on or there is a water leak; heat, to detect fires;
extreme temperatures, to detect if it is very hot or cold; and carbon
monoxide or smoke. Sensors in more sophisticated systems can link to
automatic systems that could shut off the gas supply, as well as alerting
you, your carer and/or a response centre. There are also enuresis (bed-
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wetting) sensors, which can detect moisture and can be placed between the
mattress cover and bed sheet.
Reminders
These include medicine dispensers, which use a sound alert to remind you to
take your medicine. The compartments of the medicine holder will open at
the right time, on the right day. You, your carer or care worker (or in some
cases, your pharmacist) will need to fill the medicine holder beforehand.
Voice message reminders are also available, to ask if you have taken your
medicine, or had lunch, for example. If you do not respond, an alarm is
raised.
Sensory impairment alarms
If you have a sensory impairment, these devices can sound, flash or vibrate
to tell you if the alarm has been raised. For example, if you are blind and
there is a fire, you could be alerted by hearing an alarm sound. Vibrating
alarms can also be placed under pillows, which may be helpful at night if you
have a hearing and/or visual impairment. If you have a hearing impairment
there are also beacons, which can show you visually that the alarm has been
raised, as well as inductive loop systems to help you hear the operator
clearly during alarm calls.
Carer’s alerts
If you are a carer, there are devices that feature both sound and vibrating
alarms. These alerts can help you not to worry quite so much about the
person you care for and may even help you get more sleep, knowing that
you would receive an alert should the person you care for get up at night, or
leave their room for longer than is usual, for example.
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Location sensors
These are used outside the house for you to either call for help while you are
out, or for you to be traced if you get lost.
Activity monitoring - telecare and non-telecare systems
These systems monitor the movement and activities of your household. They
give useful information on your needs and can be used by social services to
tailor a care package to your needs or to check that your existing care
package is working.
Friends or relatives can also monitor your activity to make sure that you are,
for example, moving around your home and using your kitchen at meal
times. Your relatives would, of course, need your consent to monitor you in
this way. They would also need to think carefully about if or how they could
use the information being reported. For example, just because someone is in
the kitchen, it does not mean they have prepared or eaten a meal.
Other monitoring systems may ask you to press a button at specific times
during the day to confirm that you are ok. If you do not press the button,
then staff from a response centre will phone you. Please note, not all
activity-monitoring systems are connected to response centres or are
available 24 hours a day.
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3
When to use telecare
The first thing to consider is whether telecare is the best option for both you
and your carer, if you have one. For many people telecare raises concerns,
from feeling like they are living with ‘Big Brother’, to the security of their
information, particularly with regard to monitoring systems.
There are also issues about agreeing to telecare, particularly for people with
dementia who are not able to give their consent. If this is the case, then the
people who knew the older person well before they lost their mental capacity
should be consulted, and/or the older person’s wishes and previously known
preferences should be considered. It may be helpful to have an independent
advocate to help make this decision.
Is telecare appropriate for you?
It is important to consider how you will use the sensors in order to ensure
the full benefit of the system. It may be helpful to consider the following:
•
Will you be able to use the equipment properly? Are the buttons
suitable for any disabilities you may have, for example, arthritis?
•
Can you hear the response centre staff if they should call you?
•
How will you know if you have triggered a sensor? Can you hear the
control box being activated or do you need a visual alert?
•
Will you recognise the equipment and what it is meant to do? If you
have a condition like dementia, this could be very disorientating;
you may not understand what the noise is, whether a heat detector
is sounding or where the voice is coming from if the response
centre staff are calling you.
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Even if you fully understand and agree to telecare systems in your home,
they may not suit your lifestyle, or you may forget to use them or simply not
like them. If, despite this, you would still like to use telecare, ask the
company or your local council for other suggestions of telecare devices that
may be more suitable. Your existing system may require adjusting to meet
your individual needs.
Case Study
Patrick had fallen in his home a number of times. Each time he fell, he was
not wearing his pendant because he did not like wearing it. He was assessed
for telecare and it was suggested that he could wear a fall detector on the
waistband of his trousers. Patrick felt that he would forget to put this on
when he got dressed in the morning, and he was not sure he would be able
to fit the fall detector onto his waistband, as he had arthritis in his hands. A
telecare specialist asked if Patrick ever wore a watch and Patrick said that he
did. The telecare specialist suggested that Patrick consider wearing a watch
fitted with an alarm inside it. Patrick liked this idea, as the watch did not
look like an alarm. In his review, Patrick said that he found the telecare
wristwatch easy to remember to wear and felt comfortable with it.
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4
How can I get telecare?
Different councils offer different telecare services and have different
eligibility criteria to receive telecare. You will need to contact your local
council social services to find out what is available in your area. Councils will
often include information about telecare on their website.
To find out if you are eligible for telecare from the council, you will need to
be assessed by your local council social services.
Before requesting an assessment for telecare, it is important to consider if
there is other help from the council that you may also benefit from. For
example, if you have mobility problems and don’t want to just rely on a
telecare alarm system once you have fallen, you may also benefit from an
occupational therapy assessment to see if aids and adaptations in your home
may prevent you from falling in the first place. If you feel you may also
benefit from services such as meals being delivered, attending a day centre
or carers visiting you, it may be more appropriate to ask for a full needs
assessment from social services. For more information on the assessment
process, see our guides:
Assessment and services from your local council in England
(Guide 12),
Assessment and services from your local council in Scotland
(Guide 52),
Assessment and services from your local council in Wales
(Guide 72).
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What if the telecare package offered is too limited?
If the telecare package offered is not suited to your needs, you may want to
request a re-assessment, highlighting why you think the package offered is
not meeting your needs and what additional help you require. However,
some councils restrict the telecare they offer so, if they cannot provide any
more assistance you may want to consider adding additional sensors
yourself. Since the different companies offer different equipment, you will
need to check the additional sensors would be compatible with your existing
system. You will also need to check with social services and the telecare
provider that they are happy for you to have additional sensors fitted and to
ask them whether this would affect the charges for the telecare service.
You can find out more about the different telecare products available, and
how they work, from the Disabled Living Foundation (0845 130 9177,
livingmadeeasy.org.uk). They are an independent charity and will not try to
sell you products or services.
What to do if you want to complain
If you are not happy with the assessment or the services offered by social
services, then you may want to consider making a complaint to them. For
more information about making a complaint, see our guides:
Complaints about community care and NHS services in England
(Guide 18)
Complaints about community care and NHS services in Scotland
(Guide 54)
Complaints about community care and NHS services in Wales
(Guide 74)
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Will telecare affect my existing package of home care services?
Telecare can only alert you (or someone you have selected) to something
that needs attention; it cannot replace the need for one-to-one care and
support from another person. Introducing telecare services may, however,
reduce the need for some home care visits from care workers. For example,
if you receive telecare to remind you to take your medicine, you may not
need care workers coming to remind or supervise you to take it; or if you
have regular home care visits throughout the day to make sure you have not
fallen, these could be replaced with telecare sensors which would raise the
alarm should you fall. However, it is important to bear in mind that losing
face-to-face support could end up leaving you feeling more isolated and
lonely.
The council must review your needs assessment before any services can be
cut and replaced by telecare services. As part of this review, your emotional
and social wellbeing needs should be taken into account.
If you are worried about becoming socially isolated, it may be useful to find
out if there are any befriending schemes or social groups in your local area.
The Independent Age advice service can register you for our social inclusion
projects, such as face-to-face befriending, Telephone Buddies and Live Wires,
our telephone-based book and discussion groups. We can also provide you
with the details for other national and local befriending schemes and also
social groups, depending on the services in your area; and look for local
community transport schemes to help you get out and about (0845 262 1863,
independentage.org). Your local Age Concern or Age UK (0800 169 65 65,
ageuk.org.uk) may also know of befriending schemes available to you. Some
social groups for older people may also provide, or know of, transport to help
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you travel to and from events.
How much does telecare cost?
Services provided by the local council are rarely free. You may have to pay
for telecare in full, or contribute towards the cost depending on your income
and savings. The value of your property will not be taken into account. The
council will carry out a financial assessment to decide the size of contribution
they think you can afford to make. Many councils charge a lower rate if you
receive benefits like Pension Credit or Housing Benefit.
We would recommend that you consider having a full benefits check, to
ensure you are receiving everything that you are eligible to claim. The
following organisations may be able to carry out a full benefits check, often
during a home visit:
•
The Pension Service (0845 301 3011, Wales 0800 731 7898)
•
DIAL (01302 310 123)
•
Local AGE UK or Age Concern (in your phonebook or online)
•
Citizens Advice Bureau (England 08444 111 444, Wales 08444 77 20
20, adviceguide.org.uk, or in your phonebook)
There is no set way that councils charge for telecare. Councils may charge
different rates depending on whether your sensors are connected to a call
system or you require a call out service to check on you. However, most
telecare schemes are heavily subsidised by the council, with the sensors
being provided free of charge, and a weekly charge to cover the cost of
maintenance and the response centre costs. Every council should provide
clear information on how they charge for their services.
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Can I get telecare privately?
There are many companies that sell telecare equipment, although not many
of these provide response centres or come out to visit you if a sensor is
triggered. Before buying equipment yourself, it may be worth seeing if you
can use the same response centre as the local council; and to check that the
equipment you decide to purchase is compatible with their system.
You can find out more about the different telecare products available, and
how they work, from the Disabled Living Foundation (0845 130 9177,
livingmadeeasy.org.uk) or your local Disability Living Centre. Contact Assist
UK for details of your nearest Disabled Living Centre (0161 832 9757, assistuk.org).
Does the condition of my home affect my ability to use telecare?
Many telecare sensors are battery operated so will not be affected by your
telephone connection, or the state of repair of your house. If you have a
control box that needs to connect to a response centre, this will need to be
plugged into an electrical socket and your phone socket. This means you
may need to have your telephone socket or your electrical socket moved so
they are closer together. You will also need to have a telephone connection
that is in good working order.
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5
Examples of how telecare can be helpful or
unhelpful
Supporting independence
At some point, you may find it difficult to manage in your own home but still
wish to retain your independence. You may find the thought of care workers
or family members checking in on you intrusive or it may be difficult for
family members to do so on a regular basis. Minor issues such as forgetting
to take your medicine or turning off the cooker can lead to much greater
hazards, and may be easily resolved with telecare, enabling you to continue
to live safely and independently in your own home.
Case Study
Barbara lives alone in her own flat and has always been independent and
self-reliant. She has recently had some memory problems, but is very clear
that she wants to remain in control of her life. Things came to a head when
she had a fall after forgetting to take her medicine a few times. There was
also an incident where her bath overflowed into her neighbour’s flat, when
she left the tap on while she answered her phone. Her daughter, Susan,
grew concerned about her mother’s ability to cope and worried about her
safety.
Susan wanted to keep her mother safe and started phoning Barbara several
times a day to check she was OK. Barbara was increasingly irritated by
Susan’s constant calls to check how she was and whether she had
remembered to take her medicine. Following an assessment from social
services, Barbara agreed to the installation of a medicine dispenser and a
flood detector, which would alert her if needed. This meant Barbara was able
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to take back control of her medicine, without needing to be continually
reminded by a care worker, or her daughter. Barbara would also be alerted if
she left a tap on, so she could turn it off before causing a major flood. These
simple telecare solutions gave Barbara back her confidence, as well as her
dignity. Knowing that the sensors were connected to a call system that could
offer assistance should she need it, provided both Barbara and Susan with
reassurance. Neither felt the sensors were too intrusive.
Reducing independence
You may find telecare intrusive, or feel that you are being undermined by
even the suggestion of such equipment. You may have concerns over being
monitored or accidentally triggering the alarms, or you may worry that you
will be confused by the alarms and this could make the situation worse.
You may simply feel that telecare does not provide the right solution for you
and would prefer to look at the alternatives.
Case Study
Mary was an active 83 year old who sometimes forgot to take her medicine.
One day she had a fall in her hallway as she hadn’t taken her medicine all
week. It was so serious that Mary had to go into hospital. Her family were
concerned and wanted her to consider having telecare to remind her to take
her medicine and to wear a fall detector. Mary hated the idea - it made her
feel as if ‘Big Brother’ would be watching over her, but to please her family
she agreed to have an assessment with the telecare assessor from her local
council. Talking to the telecare assessor, it became clear that Mary usually
forgot to take her medicine with her when she went out. The assessor
suggested Mary used a daily pill dispenser, which fitted inside her handbag.
The telecare assessor also arranged for a fall specialist to visit Mary’s home
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who suggested that the fall might have been due to rugs that had become
loose and poor lighting in the hallway. The local Home Improvement Agency
arranged for a handyperson to fit rug grippers so that the rugs lay flat and
for an electrician to fit additional and brighter lighting in Mary’s hallway.
Supporting mobility
As you get older your mobility may be affected, which may cause you to
have falls or worry about falling. Moving home to somewhere more suitable
could be one option but it may not always be the right solution if it affects
other areas of your life, such as staying close to friends, family and
neighbours who support you. Remaining in familiar surroundings is
particularly important for those with sensory impairments.
Telecare can provide an important safety net. With the use of fall detectors,
bed and chair occupancy sensors, and alarm buttons, you can be supported
to live in your own home, while ensuring that help can be called for, if you
need it.
Telecare cannot stop you from falling so it is important to consider asking
the council for a full review of your needs. This might include an OT
assessment, carried out by an occupational therapist, to look at minor aids
and adaptations that could help prevent you from falling or having accidents
in your home. For more information about home adaptations, see our guide
Housing: Adapting Your Home to Stay Independent (Guide 28)
Case Study
Eric had been recently widowed having shared his current home with his late
wife for 40 years. Over the last few months, he had had several falls while
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getting out of the bath. He had not been seriously injured but had been
badly bruised. His friend and neighbour for many years, Gary, persuaded
him to contact social services. Eric felt embarrassed about the falls and was
not keen to be helped to bathe by a stranger.
His social worker suggested he have an assessment from an occupational
therapist. She recommended and arranged for a number of handrails to be
fitted to the bath and bathroom, as well as a non-slip mat and bath seat. As
Eric had found it difficult to get up after the falls, and did not want to have
help with bathing, she recommended that he have an alarm button near the
floor of the bathroom, so that if he did fall he could raise the alarm. She also
recommended that he wore a wristwatch fitted with an alarm in case he fell
while walking around his home, which Eric was happy with. His friend Gary,
who already held a key to Eric’s house, said that he was happy to be
contacted to help Eric in these circumstances.
Eric felt that his concerns over his dignity and independence had been
listened to, and he felt comforted by the support package that had been put
in place. Gary was pleased that he no longer needed to worry.
Supporting carers
Telecare can provide reassurance to both you and the person you care for as
it may not be possible, or even desirable, for you to always be there.
Telecare may allow you to get some rest, knowing that you will be alerted if
you need to be. Pagers and under pillow alert devices that vibrate can be
used should there be a problem while you are asleep or out. For example,
you may be scared of leaving your spouse or relative alone, and may find it
difficult to meet friends, attend a support group or even carry out the weekly
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shop. Fall sensors, along with a personal alarm, connected to a pager, may
give both you and the person you care for sufficient reassurance to enable
you to go out.
If the person you care for becomes confused or anxious when you go out;
refuses to, or cannot, use the alarm devices, then a ‘sit in’ service may be
more appropriate. It is important to consider how the person you care for
uses the equipment and whether it is realistic that they will do so.
Case Study
Joan cared for her 70 year old mother, Gloria. Gloria had become
increasingly anxious about being alone in her home after having two falls
and often called Joan during the day and would be very worried and upset.
Having been assessed by social services, it was suggested that Gloria try
using a fall detector on her belt. It was explained to her that if the detector
was triggered, a response centre would ring her to check if she was OK. If
she was fine, no action would be taken so she need not worry about
triggering it accidentally and the police and ambulance turning up. If she
was not OK, the response centre would call her daughter, and if she could
not help, would an ambulance be called. Gloria was not sure, but agreed to
try it. After four weeks, the telecare was reviewed. Gloria said that she felt
much happier knowing help would come if she needed it, and despite her
fears she had not triggered the detector accidentally. Joan was much
happier about going out so they decided to continue using telecare.
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Supporting people with dementia
Telecare can help people with dementia to remain in their own home. This is
important so they can have the benefit of being familiar with their
surroundings.
However, it is important to consider how a person with dementia will feel
about the devices and whether alternative solutions could be used. People
with more advanced dementia may not know how to attach the fall sensor,
so a movement sensor set in their bed or their chair may be a better way of
monitoring whether they fall.
Some people with dementia may feel they need to leave their house, and
may be in danger of getting lost, or having a road accident. Property exit
sensors fitted to the door can either alert the carer when the person with
dementia has left their home, or the sensor can be linked to a response
centre who can speak to the person with dementia to try and persuade them
to remain in the property.
Case study
Adam had begun walking frequently at night. He often walked some distance
from home, along busy roads, and did not know where he was. Despite
many attempts from his carers to find out why he wanted to go out walking
at night, he was unable to explain why. It was decided to fit an exit sensor
and a communication box by the front door. The response centre could then
gently suggest to Adam that he might want to go back to bed. For Adam,
this proved very successful.
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6
Care homes and telecare
Telecare can also be useful when providing care in a care home. It can help
care workers to provide support to care home residents when it is needed,
rather than disturbing residents (particularly at night) to check on them.
Enuresis (bed-wetting) sensors let staff know when a resident needs their
sheets and incontinence pad changed, rather than having to disturb or wake
a resident up to see if these need to be changed. Sensors can also be used
to alert staff if a resident has fallen out of their bed or chair. Sensors can
sometimes be more effective than alarms or routine checks by care staff, for
example, if the resident falls and is unable to reach the alarm or if a resident
is unable to understand how to use the pull cord. They could also be less
intrusive than care staff repeatedly checking on the resident.
For residents who experience confusion or walk around a lot, sensors can be
put on their bedroom door to alert staff when the resident leaves their room
at night. This can make it easier for staff to respond quickly. However, staff
should not completely rely on sensors to alert them of the need for
attention. Residents should have additional means to communicate their
need for help and assistance. This is particularly important where someone
has a condition, such as dementia, that restricts or prevents their ability to
make their own decisions.
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7
What is telehealth and how do I apply for it?
Telehealth (or telemedicine in Wales) is a way of monitoring your health
remotely. Telehealth can monitor conditions such as asthma, heart failure,
diabetes, hypertension, chronic obstructive pulmonary disease (COPD),
stroke and drug and alcohol addiction. In some areas, telecare and
telehealth have been combined to form one system known as telehealthcare.
Equipment in your home, such as blood pressure monitors and weighing
scales, can send readings to a health professional, such a doctor or nurse,
through an internet or telephone connection. If your daily readings are
abnormal, the telehealth system will alert the health professional. You may
also be able to speak to them via a visual screen if you are concerned about
your health that day.
Telehealth can help you to return home earlier from hospital, as your
condition can be easily monitored from home. It can also reduce hospital
admissions and the need to attend outpatient clinics and GP appointments.
If you have a health condition that fluctuates, you may be anxious about
your health and unsure when to seek help. Telehealth can help you to feel
reassured that your health readings are within safe limits, and help you to
monitor the effects of your medicine.
How do I apply for telehealth?
Unfortunately telehealth is less common than telecare. It will be up to your
doctor to decide if they feel that you would benefit from this service. You can
contact your local doctor to discuss whether a telehealth scheme is run in
your area and whether they think you would be eligible.
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8
Things to consider
When considering telecare or telehealth, it is important to make sure that
you have thought about the following issues:
•
Have your views about telecare and how you would like to live
been fully taken into account? Do you consent to using telecare?
•
Do you understand how telecare will work? Will telecare make your
daily life feel safer, or will it make things feel more complicated
and increase your anxiety?
•
Will telecare increase your independence or decrease your ability to
do tasks yourself?
•
Will the data collected be protected? Is information stored securely,
both by the telecare response centre and the activity monitoring
system?
•
Is telecare really the most appropriate solution for you and have
other options been considered?
•
Have you understood the possible impacts of telecare? For
example, fewer visits from family members and friends to care for
you, or possibly fewer visits from care workers, which may affect
your social services care package or your personal budget.
•
Are neighbours, carers or relatives willing and able to respond to
an alarm or alert in a short space of time?
•
As your needs change, how will telecare be reviewed and when?
This guide is not a full explanation of the law and is aimed at people aged
over 60.
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If you would like free, personal advice on telecare, telehealth or any
issues related to social care, benefits, loneliness or isolation, please
call our advice line on 0845 262 1863.
If you have found our advice useful, please consider making a donation. We
receive no state funding and rely on income from individuals, trusts and
other sources to continue providing our services to hundreds of thousands of
people in need. For further information on how to support us, please see our
website independentage.org or call 020 7605 4288.
© Independent Age, June 2013
Independent Age
6 Avonmore Road
London
W14 8RL
T 020 7605 4200
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Guide Telecare and telehealth: what it is and how to get it

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