We spoke to Nick Weston, Chief Commercial Officer for Intelligent Lilli, as well as social worker Lisa Hope, on the topic of remote monitoring and their product Intelligent Lilli.
Introducing Intelligent Lilli
Lisa: Essentially, Lilli gathers data on a person’s behaviours within their own home.
Nick: Lilli allows carers to be proactive. Lilli provides a service and a solution that supports care workers like Lisa, and acts as their assistant, by giving them insight to support care decisions they need to make around a service user. Care workers have good instincts about a person’s care requirements, but they often lack evidence to support their decision making. Lilli provides data and insights regarding how a vulnerable person is managing at home which provides a baseline of evidence for staff to say, ‘I know that I am making this accurate decision for this person and it is in their best interests.’
Lisa: Lilli provides me with evidence over a 24-hour period about what an individual is doing at home and what their routine is. By understanding the patterns and trends of someone’s behaviours, it also tells me whether or not they are putting themselves at risk. Carers and family members can go and visit a vulnerable person to provide regular or occasional help, of course, but Lilli provides me with an additional layer of information about what happens when a person is alone, for example whether they are feeding themselves, putting the kettle on or going to the bathroom. I can also see the temperature in the house, whether they’ve gone to bed and how frequently they got up in the night, or if they’ve opened doors in the night. Ultimately it gives me the information I need to determine if they are safe.
Additionally, it means that if a family member or a neighbour challenges me on the decision I make regarding a vulnerable person. I have the evidence that Lilli provides me with to back up my decision making – for example, why I’m not putting that person into a care home. From the insights that Lilli has gathered I can show them that the person is actually safe and able to remain independent in their own home.
Nick: In terms of how it works, its simple, there’s a hub and a number of very discreet sensors that are placed into a vulnerable person’s home. It’s not reliant on WiFi to transmit data and it’s very simple for a member of the family or care worker to set up via our app.
Lisa: They’re really easy to fit -it takes me about ten minutes to set Lilli up for a new client by the time I’ve placed the sensors around their home. The first time I didn’t feel very confident so I worked with a member of the team at Lilli, I then went on to fit three in the same day with support from the team. Now I feel pretty confident to do it and I’ve since helped colleagues with set-up too. Once the system is up and running, I can keep an eye on things via the app on my phone.
Nick: It’s designed to be discreet and non-intrusive technology. A person’s privacy is very important to us – we don’t use cameras or microphones, instead we use motion sensors. A recent new development we have added is the monitoring of bathroom activity. Now instead of just being able to tell if a person has been to the bathroom, we can determine more important detail for the care worker For example, if a person goes into the bathroom for a few minutes, the platform will determine that as toilet usage. If a person goes in for a longer time period and the temperature increases, the platform will determine that the person has had a bath or shower. This is a really useful insight that allows a care worker to ascertain whether a person is able to maintain their own person hygiene or whether additional support in the form of a care package is needed.
Supporting service users
Lisa: I had a service user who lived at home on his own since the death of his wife; he had carers going in morning and teatime and his only living family member was living down in the South of England. He was a pretty independent gentleman but had dementia, and as his dementia was declining he was starting to knock on neighbours’ doors. I was starting to get phone calls from the neighbours telling me that he needs to be in care because they thought he couldn’t find his way back home. The neighbours had also contacted the family member so she would call me too.
But actually, when I referred to Lilli, I could see that he was undertaking his usual routine. Part of his routine included going out to get his shopping, and sometimes he would knock on a door for help bringing it back. But he was getting back onto his own estate and he’d known the person he was calling on for years so to him that was normal. Lilli also let me confirm that the gentleman wasn’t going out during the night and he wasn’t putting himself at risk. When I shared that data with the family member, she felt that she could respond to the neighbour and tell them that he was fine – yes he had dementia, and he was looking for some support in getting back, but he wasn’t at risk. I looked at increasing his care slightly to help him out and he continued like that for months. It kept him at home for a lot longer than it likely would have done without Lilli, because we would have had to go on the neighbour’s say so without an evidence base.
Lilli showed when we had to take action too. On the last weekend, when we decided to move him into care, he was up and down at night, he was in and out of his house. But he had about six months of living at home, where we wanted to be, with his little dog. We could give him that.
Nick: Tech gets positioned as being all about cost avoidance and cost savings. But if you deliver better quality of life for service users, then you automatically achieve both of those things too. In that example that Lisa has just given, the person at the centre of that has been able to be where he wanted to be, for as long as he safely could. That’s what it’s about – Lilli supported him to be there.
When you look at the costs, a place in a care home is currently costing a local authority around £800 a week or £3,400 a month per person. In the example above, by supporting the gentleman with care in his home for as long as possible – in this case, six months – that’s over £20,000 not spent on an unnecessary care home.
If you look at the cost to continue to support him in his own home instead, an average care package with the cost of Lilli included would be less than £10,000 over the same six months. The independence that Lilli can maintain for vulnerable people, with the efficiencies and accuracies that Lilli can achieve for social workers, plus the significantly reduced cost advantage, presents a compelling case for tech such as Lilli being adopted as a wider part of the ecosystem for care solutions.
Supporting social workers
Nick: This system is built for people like Lisa and her colleagues. We know that social workers are challenged about the care decisions they make on a daily basis – by family, neighbours, GPs, the police and others – but actually, they do know best. They are the people who have the most contact with these vulnerable people, they have personal and professional relationships. A GP can’t accurately assess that a vulnerable person belongs in a care home based on a seven-minute visit. Social workers need more support and the evidence to back them up, to help ensure that accurate decisions are made and upheld for as long as is necessary. That’s the principle of Lilli, ensuring that all stakeholders have the evidence required to support decision making that results in the best outcomes for vulnerable people.
Remote monitoring technology is not about replacing care workers with tech, it’s about providing them with a technology that enhances them in doing their job, by reducing friction and improving outcomes, thus helping them work more effectively and efficiently. In the current climate with limited staffing and financial resources within the social care sector, this can only be a good thing.
From our side, we continue to build the capability of Lilli – for example we’re launching our friends and family app, so that loved ones can also access the platform to check that a loved one is OK at home, to give them peace of mind and an understanding of when and if care is needed. That will mean that social workers and family or friends will be able to support each other and work together to the benefit of the vulnerable person.
We are also working with other health technology solutions to explore how we can integrate and support social workers with further information and evidence, to help them in their work, as well as ensuring that as many vulnerable people can remain at home for as long as it is safe to do so.
Lisa: Another situation where Lilli helped was when I put it in the home of a service user who didn’t want her care package increasing, but her daughter did. The lady had carers visiting in the morning and leaving a snack in the fridge for her, but the daughter wasn’t convinced that her mother was eating it. However, the lady didn’t want more carers coming into her home. I originally put Lilli in to support with evidencing the right way to deal with this and it ended up helping in other ways too.
After a few months, this lady had a fall and became quite unwell. The daughter kept ringing the GP, who believed that it was just a general decline in her condition and so didn’t come to visit. But the daughter was concerned that her mum’s behaviour wasn’t normal. When I looked at the data on Lilli, I saw that her routine had significantly changed and that she was very unsettled. I rang the GP myself and was able to argue my point based on the data I had available, which led to the GP making a visit. As a result of that, the lady ended up admitted to hospital because it turned out that she had three fractured ribs from the fall that hadn’t been picked up on.
That’s an example of Lilli helping the service user get the outcome that they needed but also really helping me as a social worker – the data that I got from Lilli supported me to have that difficult conversation with the GP and push for a different course of action on their part. That wouldn’t have happened if I couldn’t refer to my evidence base.
Nick: That’s the thing – about understanding about what happens behind ‘closed doors’ as it were. Many social workers have years of experience and help in so many ways, but they are reliant upon what they are told and what they witness for themselves with regard to the status of a person. With so many people within their care it’s impossible for them to identify and retain patterns and trends on an individual person’s behaviour day today. Lilli provides that layer of unseen information and generates the insights and analysis they need to draw accurate conclusions to validate and reinforce their actions. Lisa, what would you have done if you hadn’t had Lilli in place?
Lisa: I wouldn’t have been able to present my case strongly enough to the GP without it. I would probably have had to support the lady into respite, which is what the GP originally said, but it would have been the wrong outcome. She didn’t need to be in care, she needed to be in hospital.
Nick: Then there would be an additional resultant cost associated with the fact that she’d be in the wrong place. More importantly, it’s highly likely that without the identification of her fractured ribs, it would have caused her further unnecessary suffering and led to a decline of her health. The problem would not have been solved, she just would have been moved from her own home to a care home.
Personalising care needs
Lisa: Lilli also really helps at the very start of the assessment process too, in terms of working out what a service user actually needs. I fitted one recently for a lady who has Parkinson’s but doesn’t want a care package at this time, although her son wants her to be in care. She’s really lonely so she keeps ringing for an ambulance and saying that she’s got chest pains because she knows they’ll come to see her. I’m referring her to befriending services to support her but I’m hoping that Lilli is going to help by putting her son’s mind at rest. The data should show him that she is fine, she doesn’t need to be in care as I can evidence that she can take care of herself at home, and that in fact she’s just lonely and I’m helping her with that.
Nick: By utilising Lilli in a discharge setting, you can identify the ongoing level of care that they need and how this might increase or decrease over time. It means that the vulnerable person is receiving an accurate level of care and involvement in their daily lives. It also allows Lisa and her colleagues to use their time more effectively on people who need more support. By implementing Lilli we are creating capacity in the system and better utilisation of resources.
Lisa: We’ve got a lot of people on our allocation list, so no-one is able to provide support whilst they are waiting for their care package. If we used Lilli earlier in the process we could be collecting the insights and analysis we need, so by the time social workers get out to them, we know what care they need and when they need it.
Looking to the future
Lisa: The family and friends app that Nick mentioned will help. We get inundated with phone calls from family members worrying about their loved ones, wanting an update or thinking something could be wrong – if they had access to the app, they could see what’s happening in their loved one’s home. It would mean that they would be less likely to call us unless they had a specific concern, which would save time that we could put to better use in addition to putting their minds at rest.
Nick: One of our current focuses is also building medication adherence into the Lilli platform. The requirement for this is a suggestion that came from the social workers using Lilli, how it would further help them to assess and monitor vulnerable people at home.
We are also looking into looking at falls detection as well. In the future, we’re looking at exploring the usefulness of additional extremal data points such as the weather to build out a bigger picture on people’s behaviours. The system can send notifications when unusual behaviour is identified, so for example if somebody normally goes outside on a specific day of the week but they haven’t this week, that might get flagged. But if we can include weather data, Lisa or a colleague would be able to see that it was snowing or raining heavily that day, which would explain the change in their normal routine.
For me, I’m committed to ensuring that Lilli grows by continuing to give confidence and accurate information to Lisa and her colleagues and peers across the country, so that they can continue to give the best and most efficient support to the most vulnerable in our society. The bonus is that in doing that, we can help to address one of the UK’s biggest economic challenges too.
I hope everyone can see that without Lisa and her colleagues doing the work that they do, our loved ones and communities would be in dire straits. The opportunity to support them is our privilege. In society, social care workers are not given enough kudos or respect for the incredible work that they do day in and day out. A huge part of the Lilli mission is focused on giving them the best tools we can to help them.
Many thanks to Nick and Lisa for joining us.