Guidance on the benefits and barriers of virtual home assessments

Introduction

One of the purposes of a home assessment is to determine whether a home needs to be modified to accommodate people who struggle with daily activities because of disabilities and/or ill health. These people often require handrails or other adaptations to their homes to make their lives easier. Virtual home assessments could reduce the need for in-person visits and new guidelines could help develop these assessments virtually.

Researchers in Sheffield worked with service users and local health professionals (including nurses, occupational therapists and social workers) to evaluate the pros and cons of virtual home assessments. The service users and allied health professionals gave feedback on virtual assessments and the use of a new video conferencing tool. They provided insights into how the assessments and the tool could be improved.

Virtual home assessments are faster than in-person visits and may allow people to be discharged from hospital more quickly. They also cut down on staff travel time and costs. However, key concerns included the safety of personal information, the availability of devices for service users and professionals, and verification of people’s identity.

Based on insights from the focus groups, the researchers developed guidelines for virtual home assessment tools. They cover security, privacy and service user choice, among other issues, and are intended to help professionals create services that are practical, effective and secure.

Home assessments

Home assessments can take up to four hours and cost roughly £208 per visit. Conducting virtual home assessments could cut down on both time and cost.

Video consultations minimise in-person contact, which was important during the pandemic, and remove the need for travel. Remote consultations, which are being used increasingly, are cheap, short, and can allow relatives to join from elsewhere. However, disadvantages include people being reluctant or unable to use new technology.

Home Quick is a new virtual home assessment tool for video consultations. It allows a professional to control a service user’s smartphone and capture real-time notes. Researchers explored allied health professionals’ and service users’ views on the tool, and on virtual home assessments in general.

Virtual home assessments

Researchers explored the pros and cons of Home Quick at six focus groups with service users and relevant professionals. They included nurses, occupational therapists, physiotherapists, dieticians and speech and language therapists, as well as workers from local authorities and the voluntary sector.

The focus groups described the many benefits of virtual home assessments:

• They save time and money;
• They are faster than in-person visits, which means that people could be discharged from hospital more quickly;
• Recordings of visits could be shared with other bodies and reduce the need for multiple home visits;
• Virtual visits are safer for professionals because some homes can be hazardous or unhygienic;
• Virtual visits allow family members and carers to attend assessments from a distance;
• There is no need to travel, which means the same hospital could support more patients over a wider area.

However, key concerns with virtual assessments were:

• Security – service users’ personal information should not be shared without their permission;
• The availability of devices and stable internet – a lack of technology could exclude certain service users (older people, for example) and widen health inequalities for those who could not afford the internet or phone data to join a virtual assessment;
• The need for professional training to use the tool and a lack of private consultation rooms for virtual assessments;
• The impossibility of conducting some assessments remotely, such as checking for bad smells that might indicate health or hygiene problems, or measuring room size and height to plan adjustments to someone’s home;
• Being able to verify whether the correct patient is being assessed in the correct property.

Based on insights from the focus groups, a literature review and real-life case studies of virtual home assessments, the researchers developed guidelines for virtual home assessment tools (Box 1).

What’s next?

These guidelines are intended to help developers and other allied health professionals create virtual home assessment tools that are practical, effective and secure. They comply with existing health technology guidelines, such as NHS Digital’s design principles and the Topol review (NHS Digital Service Manual, 2022; Health Education England, 2019).

Virtual home assessments will never totally replace home visits. For example, where a close inspection of housing conditions is required to assess the person and their environment in context, in-person visits will still be needed. In addition, some service users may lack access to technology and the internet or prefer face-to-face in-person contact. There will be an ongoing need for in-person visits to avoid widening health inequalities. However, virtual home assessments could replace some in-person visits, avoiding unnecessary travel and the associated time and cost.

This Alert is based on user attitudes towards virtual home assessment technologies (Lanfranchi et al, 2022). Future research could investigate whether home assessment tools need to be adapted for people with specific needs, such as blindness. In addition, it could investigate whether video conferencing could be used for specific assessments, such as memory tests or examining issues with disability aids.

The focus groups were carried out in Sheffield, so future studies could investigate whether the findings are relevant in other cultural and geographical areas.