Abstract

Background: Telecare has been advocated for people ‘at risk’ because of age-related disabilities and in particular for those ‘at risk’ who live alone (to prevent adverse consequences of falls and other risks to safety). Should we therefore expect that expenditure on people living alone might differ from expenditure on those living with others, because of the presence of telecare?

Methods: Data were drawn from a large-scale cluster-randomised controlled trial of telecare in a population with social care needs in England (the ‘WSD’ study). Variations in the costs of telecare for people living alone and with others over the three months prior to baseline and to 12-month follow-up were explored by fitting multilevel models to the cost data and taking a difference-in-difference approach. The research examined total costs and costs by sector (NHS; hospital services; social care). Two-part models were employed to examine the impact of living arrangements and telecare on hospital and social care costs. Average marginal effects of allocation, time and living arrangement enabled comparison of cost differences between experimental groups over the two time points in those living with others and those living alone.

Results: The analyses drew on data from 753 cases (375 intervention and 378 control) with available costs at both baseline and 12-month follow-up. Model estimates and marginal effects of the intervention within subgroups are presented. The policy implications of the results are discussed. Telecare is a complex health and social care intervention; careful interagency coordination is needed to balance expenditure and savings across organisational boundaries.