Personal response services for peace of mind

By Elizabeth Steggles
This article originally appeared in the November/December 2002 issue of Occupational Therapy Now magazine published by the Canadian Association of Occupational Therapists

Many people living in the community are at risk for a variety of reasons. Other people are unable to live independently because they have no way of calling for assistance if it is needed. Personal response services are often used as a means of calling for assistance and enabling people to live more independently and safely. The kinds of risks that people face may be caused by illness, disability or abuse.

Personal response service (PRS), personal response system (PRS) or personal emergency response system (PERS) are terms commonly used to describe a variety of equipment and services that have similar features. In this article the term PRS will be used to cover all such equipment and services. The purpose of a PRS is to enable the user to contact a support service by telephone.

PRS offer a variety of features and prices that should be considered when choosing the best solution for an individual. In general, the user carries a remote pendant worn about the neck or on a wrist strap that can be activated in the event of an emergency. The pendant sends a radio signal to a base station, which in turn triggers an emergency procedure. In this article, the features will be considered under four categories. These are:

• the equipment;
• the monitoring station;
• the service; and
• the cost.

The equipment

PRS typically supply a pendant with a button that the user carries. When activated, the range of the signal varies from approximately 100 feet to about 500 feet (30 to 150 metres). It is important to consider what range is required for a particular user and if there is likely to be any radio interference. The reinforcing metal bars in concrete buildings are often the cause of problems so it is a good idea to have the PRS supplier check, prior to installation, that their system works well. Most pendants are waterproof or at least water-resistant. Since many accidents occur in the shower or tub, this is an important consideration. The pendants tend to have small buttons that may be difficult to activate if the user has limited fine motor skills. Some PRS offer modifications that allow the use of an alternate access method such as a pneumatic switch or a head switch.

The base stations that receive the signal from the pendant are actually telephones but they come in a variety of forms; all send a signal to a monitoring service. Some base stations are very basic and only signal to the monitoring station that a particular person has activated his pendant. Other base stations allow a two-way conversation between the user and the service. The distance from the telephone to the user obviously limits conversation. For example, if the user is outside, the service will not be able to hear him but will know that assistance is needed. Base stations that allow two-way conversations offer a significant advantage; the service is able to establish the exact nature of the problem and initiate the most appropriate action.

Some base stations may be used as regular telephones and some have special features such as inactivity timers (that let the service know if there has been no activity for a predetermined length of time), large buttons, auditory cues (to announce which number button is being pressed) or the ability to deliver reminder beeps or messages. For example, it may be beneficial for the user to receive verbal reminders to take medications at a specific time. If the user does not acknowledge the message, the monitoring service notifies someone.

Battery backup on the base station may be important in the event of power failure. The need for it should be considered.

The monitoring station

All PRS use a monitoring station but these vary considerably. Some are specialized and only service the personal response market while others are multi-purpose; for example a security service or a hospital switchboard. The specialized services tend to have staff who are trained more specifically to meet the needs of older people or people with disabilities. Such staff often have relevant backgrounds, such as nursing. Some PRS have their own monitoring station while others sub-contract. Most services indicate that they will respond to calls within one minute. It is advisable to ask if medical emergencies are given priority over other calls.

All PRS have protocols in place though some are more comprehensive than others. Typically, the respondent at the monitoring station will see a computer display as soon as she answers a call. The company’s protocol should provide the respondent with information on the name and location of the caller, the names and contact information of people or agencies that should be notified, the most likely course of action and any relevant medical details that can be passed on to an emergency service. There may also be other special needs noted such as an inability to communicate verbally or an inability to speak English or French. Some services will link with translators.

The security of the monitoring station should also be considered with questions such as: how is information stored, how is information backed up and what happens in the event of emergencies such as power cuts or fire?

The service

The primary purpose of all PRS is to respond to emergency medical situations. This enables people who are at risk to live as independently as possible with greater peace of mind. All PRS take emergency calls and pass the information to the appropriate agents, usually relatives or the ambulance service. The user or the station then resets the system. Some services, however, recognize that reassurance is often more regularly needed than a response to an emergency. Such services encourage users to activate the system if they are concerned and will also call back to check on a previously reported situation.

Another important feature of any service is the ability to monitor equipment remotely and respond to such problems as low batteries before a problem occurs. Most, but not all, services do this. Another consideration is the availability of local support and the time it takes to install service or respond to changes in the user’s needs.

The cost

With such a range in the equipment and the type of service offered by each PRS, it should come as no surprise that costs vary quite widely but are generally reflective of the service offered. Some companies charge nothing for installation, while others charge up to $60. Monthly rental varies between $25 and $45. Some services have a minimum rental period; most do not charge for service calls but the question should be asked.

In addition to PRS, there are telephones available that can be activated by a pendant in order to send a message to one or more destinations. The advantage of such a telephone over a PRS is that it is purchased outright with no monthly fee. The disadvantage is that the call may take longer to go through if it is not answered immediately or if the respondent is unavailable. It is possible to direct a call to 911 but the background information may be unavailable to the recipient. Depending on need, this type of telephone may prove a cost-effective solution.

Choosing the most appropriate service and/or equipment can be a daunting process and certainly one that people often need help with. To find local services, look in the Yellow Pages under “Medical Alarms”. Having identified specific needs, it is a good idea to ask some fairly specific questions when choosing a service. In researching this article, there was a broad range of knowledge available from sales staff and a great variation in the understanding of the customers to whom service is provided. However, if the right PRS is chosen, it can make an enormous difference to the safety and independence of the user and to the increased peace of mind of family and caregivers.

About the author

Elizabeth Steggles is an occupational therapist and manager of Independence Technologies. She can be reached by e-mail at steggles@hhsc.ca.