What are the alert systems used for? How do those receiving alerts feel about the way they work? What’s really happening out there where care services are being delivered, and how should tomorrow’s alert response centres be organised? These are just some of the questions that Elin Sundby Boysen, a research scientist at SINTEF Information and Communication Technology, is trying to answer together with researchers from the University of Agder, technology suppliers and the medical alert services.
Many people believe that medical alert systems are used primarily to raise the alarm in the event of serious falls and accidents, but in fact these only account for six per cent of cases. So say the results of a project called “M4ALMO” (Models for tomorrow’s alert response centres).
The project arranged several workshops in autumn 2015 and spring 2016, attended by representatives from Norwegian municipalities, alert response services suppliers, technology suppliers, SINTEF and the University of Agder. It emerged that there are major discrepancies between the municipalities as to how medical alert services should be organised, implemented and offered to their users.
In October 2014, the Norwegian Directorate of Health recommended commencing the transition from analogue to digital medical alert systems. This change will make it possible to utilise new safety technologies that can help enable users to reside for longer in their own homes in spite of illness and long-term disability.
Lack of research
“Care home accommodation is expensive, and most people prefer to live at home”, says Boysen. “For this reason, the overriding aim of the Norwegian authorities is that more elderly people should live at home for as long as possible. But for this to work, the elderly must feel safe at home”, she says, emphasising that there is a lack of research in this field.
In order to develop a concept of how tomorrow’s alert response centres should be organised and equipped, researchers first had to build a clear picture of the current situation.
Everyday assistance is top of the list
Researchers studied data from seven Norwegian municipalities in order to investigate issues such as what caused the triggering of medical alert systems. They found that half of those who pressed the button in fact wanted standard nursing and care services, and assistance with everyday tasks. In general, the most important reasons why many people pressed the alarm were anxiety, loneliness and a need for human contact.
“Alert systems are used for all kinds of reasons. From people who press the button for the tiniest little thing such as help to let the dog out, to those who would never use it even after a fall because they don’t want to be a bother. They cover the entire range”, says Boysen.
Medical alert systems are not a legal requirement, but all municipalities offer them to their residents. The commonest are in the form of pendants worn on the wrist or around the neck.
The project is being funded by the Norwegian Regional Research Fund by means of a joint announcement involving three funding regions for the period between 2015 and 2017. It involves participation from municipalities in the three funding regions Agder, Oslofjorden and Oslo. The research partners are SINTEF and the University of Agder. The latter has responsibility for heading the project.
To date, the project has obtained an overview of how medical alert response services currently operate, and has published two reports. The first is called "Responssentertjenester i helse- og omsorgstjenesten: behov og fremtidsbilder" (The role of medical alert response centres in the healthcare services: needs and visions), and the second "Studie av utløste trygghetsalarmer i syv kommuner" (A study of triggered medical alert systems across seven municipalities).
Difficulties for home care personnel
Home care services personnel are responsible for responding to medical alerts in more than half the municipalities studied. Feedback from these indicated that they found it difficult to answer the phones connected to the alert systems, especially when they were attending to another user.
One of them said: “If we receive an alert when we have our hands full doing other work, it’s easier to say “I’ll be along when I’ve finished” rather than spending a lot of time trying to sort things out over the phone”.
Need for alert response centres
Researchers also found that there is an urgent need for alert response services and, in particular, for alert response centres that can receive and systematise alerts and notifications.
In Oslo there are private sector companies such as Doro Care and Aleris/TelenorObjects that receive alerts and respond by sending staff out to homes when the alerts are triggered. In other municipalities there may be fire alarm services. Kristiansand municipality has been assigned the task of establishing a municipal-regional alert centre as part of a pilot project looking into how such centres should be organised.
The next stage in the project will be to develop models describing how such centres should be equipped and how the individuals and organisations involved should interact.
Tomorrow’s alert response centres
Currently, most medical alert systems work only in homes and are connected to landline phones.
However, the analogue network will be shut down next year so there is a need for digital systems.
“Such systems will offer many opportunities to hook up different types of alert systems, including sensors that detect everything from falls to situations where people forget to turn off the cooker or close a window”, says Boysen.
“We see the future as a network of such sensors monitored by an alert response centre”, she says.
Boysen and the other researchers have drawn up a list of key features that such centres should offer. These include:
- Health professionals with suitable personal characteristics
- Access to updated information concerning all users’ individual situations, services and previous incidents (users’ records)
- Standardised procedures for call-outs and monitoring
The mantra is service individualisation
The transfer of effective information about users’ needs to those who receive and are called out in response to alerts is key to tomorrow’s medical alert systems.
“In a way, service individualisation is becoming the mantra”, says Boysen. “If such a system involving a variety of sensors is to work, it must be closely adapted to the individual. It’s no good having an alert go off for someone who habitually gets out bed in the middle of the night just to sit and watch TV”, she says.