Localization technologies (GPS)

Digitalisation can be increasingly important for enabling municipalities to offer quality health and care services.

The exception is Oslo Municipality, which has adopted localization technology for service recipients in dementia care as part of the “Samhold” project. Several municipalities have been involved in the SINTEF-led project "Trygge spor", which has conducted an effect study based on experiences from 19 municipalities and prepared a service model for how the municipalities can use GPS for people with dementia (Ausen, Svagård, Øderud, Holbø, & Bøthun, 2013).

In the past year, several of the municipalities have offered location technology as part of their rehabilitation service. For users with a mental retardation, virtual fences (Geofence), which issues an alert when users enter and exit a geographical area, providing great security and freedom to travel outdoors. This, in turn, has contributed to the increase in activation, which is a goal for many in this user group. Devices featuring two-way voice function can be useful, but not all users know how to use the function, it must often be used some time to enter into a dialogue. Finding technology that is reliable and has good usability is challenging (Søndre Land municipality, 2016).

Other essential prerequisites to be solved to ensure the volume and success of this kind of service include good systems for the response service, procurement practice, integration of patient record systems, changes in mindset and, most of all, solutions that meet the users’ needs.

From 2013 to 2016, 31 municipalities were included as development municipalities in the programme.  Currently, in the escalation phase, 80% of municipalities in Norway are engaged in the programme. The NVP is providing a wide range of implementation tools and support to the municipalities engaged in the programme. The tools and support offered by the programme comprise:

• National Recommendations
• Guidelines for service innovation and benefits realization management
• Guidelines for implementation: Roadmap and quick guide
• Courses in “Velferdsteknologiens ABC”
• Process support
• Conferences, workshops, seminars

Different kinds of localization technology have been tested by the municipalities of Larvik, Skien, Oslo, Bergen, Stord, Bjugn, Bærum, Drammen, Trondheim, Åfjord, Sarpsborg, Vestre Toten, Søndre Land, Lyngdal, Sirdal and Kvinesdal. The majority of these municipalities have received funding for testing from the national programme. The exception is Oslo Municipality, which has adopted alarm and localization technology for service recipients in dementia care as part of the “Samhold” project. Several municipalities have been involved in this SINTEF-led project "Trygge spor", which has conducted an effect study based on experiences from 19 municipalities and prepared a service model for how the municipalities can use GPS for people with dementia (Ausen, Svagård, Øderud, Holbø & Bøthun, 2013).

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The municipalities have also worked systematically on profit planning, as well as identifying good measurement indicators for welfare technology, evaluation and documentation.

From 2017, the NVP programme entered the dissemination and escalation phase. The transition to operational phase can be critical. For some municipalities, the transition will be greater than for other municipalities as they have chosen different ways of implementing the new services. Some municipalities have chosen to utilise the technology solutions and set up the organization, adapted and further developed the service as more service recipients arrived. Others have chosen to set up and prepare the service for a high number of users before deploying the technology, which has required a lot of advance work. Regardless of which approach the municipalities have chosen, it is important that the transition to ordinary operations is considered early in the process.

• Qualitative benefits.The most frequently mentioned qualitative benefits are an increased sense of security and freedom for service recipients, relatives and staff in the care service. For relatives and employees, security is associated with the certainty that users can be located if they do not find their way back. In Drammen municipality, 28 people have received the positioning service. The most important benefits have been increased quality of life for users and their relatives because users have a secure and more active everyday life, as well as enhanced social and mental stimulation. Users can also stay home for longer (Drammen municipality, 2016).

• Freedom and absence of coercion. For almost 70% of users in a survey in Larvik municipality, GPS means that relatives or staff do not need to divert or prevent a person diagnosed with dementia or cognitive impairment from going out. 70% of respondents in the Larvik survey in also believe that there are less conflicts if users are able to go out when they want to (Ausen et al., 2016). The experience of Bærum municipality is that the use of localization technology is the least intrusive measure for certain users. Users who want and need to use localization technology would like to maintain their autonomy and freedom (Bærum, 2016).

• Stay longer at home and postpone further services. The majority, if not all, of the municipalities that have piloted localization technology have noted that service recipients can stay longer at home or postpone the need to start using other services. Skien municipality estimates that 15%–20% of users will benefit in the form of a delayed requirement for service escalation or placement in an institution (Skien municipality, 2016). However, documenting how long the needs of one complex disease picture can be delayed is challenging, and where localization technology is often a measure in combination with bother measures such as home services and day-care services (Ausen et al., 2016). Preliminary figures show that users in Larvik municipality postponed other services offered by the municipality for approx. 3 months (Larvik municipality, 2016). In Bærum municipality, several residents with dementia in the institution were able to remain longer in the open unit, where the alternative would be a sheltered department (Bærum municipality, 2016). Both Bærum and Larvik also reports on users who have been able to move home from institution using localization technology. Duration of resettlement has varied from a few weeks to several months; one a person who lived in a sheltered department for dementia at a nursing home in Larvik municipality lived still home, 4 months after moving from the nursing home. Drammen has made an estimate based on 11 inhabitants with cognitive impairment who triggered the exploration action before they got localization technology. These would normally have been assigned institution space. Seeing where long as these have continued to live at home with localization technology, the municipality has estimated savings per person based on 24-hour price for nursing home space (SEK 3196) and distributed on associated year. In 2014, the municipality expects to have saved NOK 2 109 360, ie NOK 124 000 per User. The expected number of users in 2016 is 28, which gives a potential total saving of 3,474,240 NOK (Drammen municipality, 2016).

• Avoidance of search and rescue operations.The municipalities' experience in providing localization technology confirms findings from earlier reports to the National Program for Welfare Technology and major trials such as "Trygge spor» and «Samspill»: This service avertes major search and rescue actions. There are no statistics on the number of annual search and rescue actions for people with cognitive impairment or dementia, but when the emergency services and voluntary work expire, society uses considerable resources on this. The number of avoided search and rescue actions averted in each municipality cannot be determined with certainty either. But Drammen municipality has made a calculation based on people who have previously triggered search and rescue actions and which have now received the service. The time is retrieved by the user being able to locate quickly via GPS and avoiding major search and rescue activities, and Drammen municipality expects to save 548 hours (0.32 man-years) in 2016 (Drammen municipality, 2016).