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Living Alone: A Guide to Medical-Alert Systems

Fees · Products · Services

Personal emergency response system, or “medical alert,” devices can help senior citizens to maintain their independence later in life, but we’re concerned that some people are scared into making a purchase by fear-based ads. Nonetheless, we’re excited about research that’s underway to make the devices capable of predicting problems.

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It used to be that after you reached a certain age, the remainder of your golden years likely would be spent living in a family member’s home or in a nursing home. However, in recent years, increasing numbers of senior citizens choose to live out their life in their own home.

A 2011 survey (most recent data available) by AARP and National Conference of State Legislatures shows that about 90 percent of seniors want to avoid a nursing or retirement home, although 82 percent recognize that they might require assistance or continuing care in retirement.

The ability for senior citizens to live in their own homes is known as aging in place. A wide range of information, products and services now make it possible for seniors to do just that.

One such tool is a personal emergency response system (PERS). These so-called medical-alert devices can help a senior citizen to get assistance quickly in the event of a health emergency. These devices, which first were marketed in the United States in the 1980s as a way for senior citizens to call for help when they were unable to reach the telephone, now can be used independent of a phone line. In some cases, the devices can detect if a senior citizen falls and place a call for help automatically if the fall renders the user unable to speak or activate the device.

We believe that a PERS device is a useful product. However, even the best PERS devices have drawbacks. Worse, manufacturers’ use of scare tactics prompts some consumers to buy a PERS device, for either themselves or a loved one, without fully understanding the product. Meanwhile, researchers are working on a new generation of PERS devices that eventually could alert health-care providers that a fall or other health emergency is imminent.

KEEPING TABS. Most PERS devices that are available to buy or rent consist of two basic parts—a base station, which plugs into a phone jack or relies on a cellular signal, and a wireless remote that typically is worn as a pendant around the neck or on the wrist. Pushing a button on the pendant activates the base station to place a call for help, although many companies also provide pendants that are designed to be spoken into directly. In most cases, the person who’s in need of help communicates with a representative from a monitoring service through a microphone that’s located on the base station or the pendant. Base stations can pick up sound 150–1,500 feet away, depending on the product. The representative assesses the situation and gets the distressed person the necessary help.

Most companies provide three types of systems: traditional, home-based cellular and mobile.

Click chart above to view full presentation

Click chart above to view full presentation

The traditional system is “the bread and butter of this industry,” according to Alan Wu, who is a spokesperson for Bay Alarm Medical, which makes four different PERS devices. These devices require a home phone line and an electric outlet, but a backup battery keeps units operational for 24–96 hours in the event of a power outage. The average cost of a traditional PERS device and basic service is roughly $30 per month.

However, landlines are being phased out. AT&T, for example, announced in 2013 that it would end landline service by 2020. More PERS devices than ever before are designed to be compatible with cable-based or Voice over Internet Protocol (VoIP) telephone services. Cable-based and VoIP services typically are less expensive than traditional landline service is, but Chris Hendriksen, who is the CEO of VRI, which sells PERS devices, points out that cable-based and VoIP services can slow during high-volume periods. Such a time is difficult to predict, he says, but the result for someone who has a PERS device is that a call for help could be delayed or even dropped.

Cellular PERS devices emerged on the market about 4 years ago, according to Harry Wang, who is an analyst for market-research company Parks Associates. These PERS devices work much the same way that conventional systems do; they just don’t require a landline. The cost of the necessary cellular service to connect with the monitoring company is included in the rental price of the unit, which typically costs $10 more per month than does a traditional or cable/VoIP PERS device. Wang says cellular PERS devices are subject to the strength of the cellular signal that’s in your home.

Mobile PERS devices, Wang says, started to gain ground in 2013. The devices can be carried like a cellphone when a user leaves home. The majority of them also have GPS technology that enables medical workers to find the user in case he/she is unable to give details about his/her location—down to the precise location, such as in a vast parking lot, as opposed to just an address. Mobile PERS devices typically must be charged every 24 hours to remain operational.

SOUND ADVICE? Aging in Place Technology Watch says 52 percent of PERS device owners learn about the device from a health-care professional. We didn't find examples of doctors shilling for the products, but you should take their recommendation with a grain of salt.

SOUND ADVICE? Aging in Place Technology Watch says 52 percent of PERS device owners learn about the device from a health-care professional. We didn't find examples of doctors shilling for the products, but you should take their recommendation with a grain of salt.

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They also typically are the most expensive PERS option. A mobile PERS device/service costs at least $10 per month more than a cellular PERS device/service does. However, Wang forecasts that the monthly rate of both a mobile and cellular PERS device/service will fall by $10 during the next 5 years.

If you opt to buy a PERS device outright, you should know that it likely will be useless unless you also subscribe to the service. Of the 12 ownership models that we found, only two LogicMark devices—the Freedom Alert ($300) and the Guardian Alert 911 ($200)—connect you directly to local 911 service. The other ownership models that we found range from $50 to $300 for the equipment, but they also carry monthly service charges that range from $14.99 to $30.

Companies tell us that consumers sometimes buy a device outright with the idea that their health might deteriorate in a few years and it would be good to have on hand then. They then can activate the monthly service when their health starts to deteriorate. If the service isn’t activated, however, the device can’t be connected to a monitoring service and won’t place the call for help.

Jon Pynoos, who is a professor of gerontology at University of Southern California, says that, because conditions differ from home to home, before you lock into anything, you should look for a PERS device provider that will grant you a trial period to determine whether its device is compatible with your landline or receives a strong cellular signal in your home. Companies that provide such trials typically do so on a 1-week or 1-month basis.

AT YOUR SERVICE. Most PERS devices are rented, not owned. According to Laurie Orlov, who is the founder of Aging in Place Technology Watch, which analyzes PERS devices, the average consumer uses a device for up to 3 years. Experts with whom we spoke say it typically is less expensive to rent a PERS device on a monthly or semiannual plan than it is to buy the device outright and purchase service separately. Renting also provides you with flexibility if your needs change.

Click chart above to view full presentation

Click chart above to view full presentation

Most companies provide the PERS device and monitoring service at a monthly rate, although 10 of the 18 companies that we researched provide discounted rates for paying quarterly, biannually or annually. Longer term contracts can reduce your monthly rate by up to $10.

At least five PERS device providers charge an activation fee, which ranges from $29 to $50. We also found 10 companies that charge a fee of up to $400 to cover the base station or the device itself if the parts aren’t returned to the company when service is canceled. In certain cases, fees for unused months that are part of a long-term contract are refunded if service is canceled because of death or a change in living arrangements. Other companies allow consumers to transfer service for unused months to another person.

Linda Rhodes, who is the author of “The Essential Guide to Caring for Aging Parents,” says it’s important to get the specifics from each company about fees that are associated with activation, cancellation, equipment and service. (See “Top Values in Personal Emergency Response Systems” for a rundown of seven PERS devices and their associated fees and service.)

MAKING THE CALL. Although PERS devices sometimes are referred to as “medical-alert devices,” the devices themselves don’t perform a medical function in the same way that, say, a blood-pressure monitor or a heart monitor does. For that reason, little regulation exists in the market for PERS devices. Federal Trade Commission provides basic information about PERS devices on its website, but the agency’s only recent regulation of those devices has been to stop robocalls to senior citizens in which shady companies tried to get access to bank-account information. According to FTC, if you didn’t provide written permission for a company to call you, then the robocall is a scam.

Regulation for PERS devices is limited largely to Federal Communications Commission, which requires that companies that sell the devices prove that they have the communication networks in place to link their clients to emergency help. We didn’t find any examples of regulation at the state level, either.

In most cases, our research found that the call centers that respond after you or a loved one presses the emergency button aren’t staffed by emergency medical technicians. Instead, it typically is workers who are hired by the companies that sell the devices. Call-center workers connect you to local 911 service or dispatch local help themselves. Experts with whom we spoke say you should ask a PERS device provider to tell you who receives the call in an emergency.

Unfortunately, you won’t have a clear picture of the quality of a particular call center. We found that call-center employees undergo various levels of training that can last 6 months or occur every 2 weeks. We also found PERS device providers that claim varying levels of certification—either to their own standards or to those of UL or trade associations, such as Central Station Alarm Association (CSAA).

Experts tell us that, in most cases, the companies that flaunt certification do it primarily for marketing purposes. However, they add that because a call-center employee has to direct an emergency call to the proper authorities, he/she has to have at least minimal knowledge about how to handle the situation properly. In other words, the experts say, a PERS device provider’s call center won’t be stocked with unqualified teenagers. Our research didn’t turn up any reports of malfeasance in these call centers. In the end, it’s worth noting that CSAA and UL certifications are respected in the industry.

When it comes to additional call-center services, three companies, Lively, Philips Lifeline and Verizon, text a family member or nearby friend simultaneously when they receive an emergency call to apprise them of the situation. ADT, CST, Medical Guardian, MobileHelp and Philips also provide PERS devices that have fall-detection technology for $10 per month on top of their monthly service, which costs at least $35 per month. The devices, which carry accelerometers to detect sudden changes in position, place a call for help when they detect that the user is falling—even if the person is unable to press a button.

FEAR FACTOR. According to a 2013 report by Orlov, PERS devices have become a $1 billion to $2 billion industry whose clientele is “mostly women living alone.”

Falls are a serious concern for senior citizens, according to Andrew Carle, who is the founding director of Program in Senior Housing Administration at George Mason University. He says falls are the leading cause of death that’s caused by injury for individuals who are older than 70, and 1 in every 3 people who are 85 and older fall each year.

Those types of statistics make the market for PERS devices one that relies heavily on consumers’ fear, according to Pynoos and other experts whom we interviewed. Commercials that show people who fell down a staircase, for example, are “clearly aimed at scaring people” into obtaining a PERS device, Pynoos says. He adds that such commercials typically run during daytime programming, when senior citizens are most likely to be watching TV.

Rohit Bhargava, who teaches a course on global marketing at Georgetown University and is the author of four books about marketing, says the goal of fear-based marketing is to produce an emotional response to an ad and an immediate reaction to get you to buy a product. If you see a commercial for a PERS device in which a senior citizen fell, you might think of yourself or a loved one in that situation immediately and believe that the advertised product is necessary to allay your fears. The result, Bhargava says, is “you very rarely actually do a little bit of research or knowledge-gathering to see whether there’s something better out there.”

Carle and Louis Tenenbaum, who is a consultant for aging-in-place systems and communities, say the best time to research and select a device is before the conditions that lead to a fall arise. Carle says that if senior citizens have regular checkups and doctors notice that a patient is starting to lose his/her sense of balance, then it’s time to start shopping for a PERS device.

Rhodes suggests that when a senior citizen begins to live alone—perhaps because he/she was widowed recently—he/she should have a PERS device. At that point, she says, senior citizens haven’t experienced much time alone, so it’s easy for them to forget that “there won’t be someone there who will be able to make that call should you start having symptoms of a stroke or heart attack.”

FUTURE MOVES. Obviously, PERS devices don’t prevent falls. However, Carle suggests that the next step for PERS devices will be the evolution from a device that alerts someone that a health emergency happened to one that anticipates an emergency.

Research is underway to make that step. Dr. Marilyn Rantz, who is the associate director of Interdisciplinary Center on Aging at University of Missouri, is part of a team that’s developing technology so PERS devices could detect functional and health changes early enough to catch problems before a damaging fall or a health threat emerges.

The system uses sensors that can be placed in floors, under a mattress or on shelves. On average, Rantz says, the system detected changes in sensor data up to 2 weeks before an emergency-room visit, a fall or the hospitalization of a patient. A call center that was armed with such data could alert the senior citizen, a family member or a doctor ahead of any incident to prevent it.

ProactiveSense, which manufactures sensor-based devices, is working with Rantz’s team to put this system into hospitals and certain health facilities. George Chronis, who is the company’s CEO, says ProactiveSense might make a product that incorporates this system available to consumers in 2015, but that “it makes more business sense to talk to larger potential customers like hospitals and living facilities, for now.” Chronis declined to estimate how much such a system would cost to a consumer, but we suspect that it wouldn’t be priced at an entry-level rate.

Meanwhile, researchers at Villanova University are developing a system that would use Doppler radar in home walls to emit electromagnetic signals that would detect falls and immediately alert family or emergency responders. Moeness Amin, who is the director of Center for Advanced Communications at Villanova, tells us that the radar identifies actions that include falls, lying down, sitting and walking, and the technology can distinguish between them to reduce false alarms. He adds that the power that the device emits is the same level as that of your smartphone.

Villanova’s system should be ready for investors by the end of 2014, but again, it’s too early to determine when such a system might be available to consumers. Amin tells us that Villanova’s system should be priced comparatively with a home-security system, but outfitting one room with multiple units could cost at least $1,500. That’s at least three times the cost of the most expensive PERS device that we found that’s available for you to own instead of rent.

We’re encouraged that research is steering PERS devices to be proactive devices instead of just reactive devices, but increased peace of mind, it would seem, comes at an increased price.

Mary Anne Dunkin is a freelance writer who, in addition to co-writing the book “The Caregiver’s Survival Handbook,” is a contributing editor to Arthritis Today.

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