Name: DILO01
Job Title: Mobile Warden
Organisation: Telecare Cardiff
Local Authority: Cardiff Council
Introduction
Telecare Cardiff is a 24-hour telephone link to the community alarm and response service that allows users to stay safe and independent in their own home. Serving over 4,500 customers across the city, this vital service is a lifeline to so many people living on their own as well as to couples and families. Mobile Wardens are required to visit the home of a person who has triggered an alarm call, thus playing a huge role within the response service.
A Mobile Warden mostly helps elderly and vulnerable people with falls, ‘assists,’ and checks their general well-being. DILO01 conveys a genuine desire to help and support others and highlights thorough enjoyment through her job. Being a Mobile Warden can be extremely rewarding if you enjoy helping others, although, the role is not widely recognised by the public. A Mobile Warden plays a huge role in taking unnecessary work from the Welsh Ambulance Service and providing peace of mind for families and service users. Even though falls are a serious health problem and cause of frailty in older adults, Telecare is not deemed an essential service, so the role of a Mobile Warden is often undervalued.
The response service covers all of Cardiff and some parts of the Vale, with only two Mobiles on shift at once. Each one working independently. The service is already feeling the pressure, although DILO01 believes they will struggle if it expands further without obtaining additional staff.
Technology, training, and staff capacity
Within the team there are twelve Mobile Wardens, two to a shift. Shift patterns include days, afternoons, and evenings. A Mobile Warden works alone and attends incidents solely, unless the call requires two to attend (e.g., physical/mental demands). However, a Mobile Warden works collaboratively with an Operator (whose role is based in the office on the phone line). Thus, the roles of an Operator and a Mobile Warden go hand in hand. The number of people who are seen by a Mobile Warden during each shift varies, therefore some days the role is busy whereas other days not so much. Afternoon shifts are the busiest due to road traffic. During the observational visit, DILO01 visited eight individuals. Each visit offered a different insight into the role, including a ‘zero response,’ a ‘welfare check,’ ‘an assist,’ and a ‘diary job’ (which is a pre-booked appointment).
The types of technology a Mobile Warden uses include a radio (to communicate with an Operator) and a work phone. They also deal with telecare technology within people’s homes which may include battery changing. Telecare includes alarms, sensors, and detectors. Radios enable safe operations by providing a way of communication between a Mobile and an Operator. Operators oversee who a Mobile Warden assists and in which order. There are three levels of response to a call;
- Zero - urgent call for help, taking priority over any other call. Telecare Cardiff get frequent zero response calls from users with cognitive disabilities as they forget what their pendant is for. These users are well known to the service although, a Mobile Warden will always treat a zero response with the same level of urgency.
- Level one – when a user is classified as injured/hurt
- Level two - the user is safe but still requires help.
When a radio call comes through from an Operator, a Mobile Warden will pull over to a safe location to discuss the incident further and obtain details. The Mobile Warden will then telephone call the Operator to transfer details. The Operator verbally communicates key information to allow the Mobile Warden to gather an understanding of what they are dealing with beforehand. An Operator will also provide them with information such as injuries, whether the person is responding, or whether they have carers with them. Radios also allow Mobile Wardens to call for back-up quickly if the incident requires more than one person.
A Mobile Warden is required to fill in a report which is specific to each user and each incident. This includes the arrival and finish time, tasks conducted e.g., assisted user in getting up, status of injury/user at present, steps for moving forward. This provides visual documentation of calls addressed by each Mobile Warden within the day. Mobile Wardens are responsible for handovers at the beginning and end of every shift which must be done in 30 mins. This can put the Warden under pressure, especially if a call comes in during the process. Mobile Wardens have limited involvement with the Ambulance Service despite taking a lot of their calls.
Telecare Cardiff is very safety conscious: all keys have individual ID’s which are logged on the system rather than names or addresses. If a user requires further support that cannot be met, a Mobile Warden will signpost them to the Independent Living Service. A Mobile Warden will put in a referral to the operators at the end of their shift which enables users to receive additional help.
Benefits of the role
The role of a Mobile Warden is hugely beneficial in preventing unnecessary ambulance callouts, providing faster response times to those in need, and helping people remain independent for longer. DILO01 finds her job extremely rewarding as she gets to help people who are in need the most. The sheer importance of a Mobile Warden was captured first-hand by experiencing the usefulness and value this service provided by assisting several users each day. Users were very thankful and appreciative of the service. It was evident that many users would have been waiting several hours without the help of a Mobile Warden, which could have caused additional complications. A Mobile Warden can get to a person much quicker than the ambulance service because it is their sole purpose. This is not only efficient, but also provides economic benefits. For many incidents it is unnecessary for an ambulance to be called for example, if the fall is not serious enough to need medical attention. If the fall results in a significant injury the Mobile Warden will wait with the person until help arrives, providing reassurance.
Challenges of the role
Despite being very rewarding, there are some notable challenges associated with the role. Due to the fast-paced, busy environment in which a Mobile Warden works the job can be very demanding and high pressured. Mobile Wardens are often in a rush to get to a user (particularly a ‘no responder’) in case of serious emergency and to prevent long-lies. However, road traffic is a huge restrictor to response times, especially if a Mobile Warden must travel from one end of the city to the other. This struggle is exacerbated by a limitation of staff. Depending on the number of calls and the urgency of them, there are sometimes not enough staff members to cope with the demand on this service. Additionally, the service is beginning to take on more users with disabilities and mental health problems. Due to this, some users require reminders that the service is for emergency purposes only as unnecessary callouts (such as when a user has pressed a button for no reason) restricts assistance to those in most need of help. Some situations can be mentally challenging for DILO01, so additional training surrounding mental health would be useful to better support users, as well as Mobile Wardens themselves.
Lone working is a potential risk identified and associated with the role of a Mobile Warden. Although there are trackers on the vehicles and radios for communication, it is suggested by DILO01 that Mobile Wardens should be in twos on a night shift to increase safety. DILO01 also noted that it would be useful to have male-female partners due to some situations (e.g., risk of accusations). There are limited Mobile Wardens, so working in twos would decrease response times. However, technology to increase safety at night and provide reassurance for Mobile Warden’s may be useful. Nevertheless, because a response service is not seen as essential it is difficult to justify such needs.
What is needed to improve the service?
All paperwork is currently handwritten by a Mobile Warden and digitally transferred by- another member of staff onto the system. DILO01 highlights a need for a better way of communicating such as iPads or tablets. A more reliable system would save time and prevent mistakes caused by human error. In addition to this, a different structure such as on-call/non call warden rota may be useful to assist during busy times, not leaving those on shift rushed off their feet.
Access to bus lanes would be ideal to allow Mobile Wardens to reach users faster. If roads were easily accessible to the service, response times would be quicker thus improving user outcomes. Although, this is very difficult when the service is not deemed essential. A response service is largely unheard of; the work carried out by a Mobile Warden is not widely recognised. More effort should be placed on increasing awareness and educating the public.
DILO01 describes Telecare Cardiff as an ideal service although recommends that some areas require attention. These include advancements in technology, and additional resources for maintenance on vans. Mobile Wardens are currently responsible for van maintenance which takes up time in their working hours, preventing access to users.
Conclusion
Detectors and sensors are brilliant as they alert Telecare Cardiff when a user is in danger and in need of help. A Mobile Warden service offers another level of care as they can assist in person. It is evident that a Mobile Warden provides value to elderly and vulnerable individuals by assisting with falls, preventing long-lies, and functioning as a steppingstone to a higher level of care. However, this is often unnoticed and under rewarded by the general public. As demands on the service shift, coupled with evolutions in ways of working, it would be beneficial to consider digitalisation of paperwork in conjunction with training. Advancements in technology could allow the service to better support their users, providing a more efficient point of care.