Telehealth and Telecare

Current models of healthcare are becoming unsustainable all over the world, due to people living longer with chronic diseases, and new costly technologies being developed. The number of people needing care is set to quadruple by 2050, placing extreme demands in terms of costs and provision of care workers.

In Scotland, the government have estimated that if the current requirements for health services are extrapolated to meet this demand, they will need to open a new 300-bed hospital every three years, and by 2050 all school leavers would be needed by the caring professions.

The choices seem stark - pay more, cut back to a bare bones service, or find an alternative. For some time UK health policy has been moving towards better prevention.
Early results from telehealth are promising

Telehealth uses technology to empower people to manage their own health and wellness. It encompasses a wide range of services ranging from text messaging and telephone-based coaching through to remote monitoring of vital signs. The technologies range from simple devices that people with only the most basic IT skills can use, right up to highly interactive services linking wireless medical devices to applications on smart phones.

Most systems are built around the need to collect and transmit data from patients, but they could encourage patients to adopt self-care regimes, including better adherence to medications.

Telehealth could help to prevent conditions with high care requirements. Until recently, prevention was the domain of public health, and divorced from mainstream health delivery, but it is now becoming a major driver for the way all healthcare is provided. The US Veterans’ Administration recently reported some remarkable results from their large-scale implementation of telehealth - including a 25% reduction in bed-days of hospital care.

Continua Health Alliance is a non-profit, open industry coalition of healthcare and technology companies which aims to promote telehealth.  First formed in 2006, the coalition brings together technology, healthcare provider, pharma, consultants (including PA Consulting) and academic organisations to work with governments and standards organisations to create a sustainable technical environment for these services.

So what is stopping a wider adoption of telehealth? Some of the obstacles are common barriers in healthcare, such as a paucity of high-quality evidence, limited knowledge (and therefore acceptance) by the professions, and dysfunctional reward systems that pay for work done rather than outcomes achieved.

There are also real concerns around privacy and security for medical information. Other issues are more pertinent to the telehealth arena.

There are concerns about the scalability of current technologies, particularly around the lack of interoperability and integration with core health IT systems. These limitations restrict the scope of services to very specific audiences, creating issues of inequity. The small size of the current market means that the available solutions are often expensive, forcing a focus on patient groups that incur the highest immediate costs at the expense of earlier prevention.
Realising the potential of telehealth

Healthcare providers will have to take a pragmatic approach to implementation, building capability and capacity in order to meet the wider expectations for health system reform.

This will require:

• A vision that sets the development agenda, clearly identifying the benefits and priorities

• Laying the foundations for scalable services within the limitation of current technology

• Expanding accessibility by working collabora-tively to shape technology enhancements.
Setting the agenda for development

Understanding the clinical and economic drivers behind healthcare needs is vital. This requires populations to be carefully segmented to identify priority targets and use this to select the most appropriate technology platform.

Telehealth services span two potential target groups at two extremes of the spectrum. The first group are those who are likely to experience an expensive care episode in the near future. This model focuses on short term savings from avoidable hospital stays, investigations and urgent treatments. Typically, this involves complex cases in the advanced stages of a chronic disease. The majority of patients are in the over-75 age bracket, which means their ability to use technology is a major issue.

The second scenario is to provide early intervention to help patients improve their lifestyle. In this model, the target population is larger, and typically represents a much younger and active demographic who are more likely adopters of new technology.

The main return from this investment will be seen only in the long term, potentially decades away, and this presents difficulties for investors faced with more immediate priorities. It also poses questions about sustainability as there is a paucity of evidence of the long term outcomes.

Deploying effective solutions requires a clear vision for who needs to be targeted, how their needs can best be met by technology and a sense of timing to reach out to people when they are likely to be most receptive to a change.

Some clinicians are torn between the value telehealth delivers to a patient and the distraction and load it places on the medical profession. This is typically a symptom of small operations where size prevents consideration of a broader service redesign that could achieve economies of scale.
Telehealth places a new and significant workload into the clinical domain

Experience from the UK suggests that a large proportion of activity is low level, such as firstline investigation of missing or anomalous results. Automation of some tasks, and filtering others using less costly resources, would address the low ratio of patients to clinicians evident in smaller operations. Investing in larger deployments is critical to achieving scale economies and ensuring telehealth services reach their true potential.

Risk stratification tools for identifying suitable patients are becoming increasingly more accurate, but this means complex information needs to be pulled in from disparate sources.

It is no coincidence that many of the early telehealth adopters, such as the Veterans’ Administration, are organisations that use information from electronic patient records to identify and manage their patients.

Without such tools there is an increased risk of wasting resources on people who are unlikely to benefit.
Work within limits of current technologies

Initial investments typically focus on areas where there is confidence of a return. The greatest potential appears to lie somewhere in the middle of the patient risk spectrum, where a relatively large number of people may become the more complex cases of tomorrow, and thus offer a relatively fast return on investment.

However, this group is also likely to have very different technology preferences to higher risk groups, typically needing services that fit with a more active lifestyle.

The largely proprietary nature of current technologies forces a choice, or leaves the provider with significant overheads from managing multiple remote monitoring systems. The future holds the possibility of more flexible monitoring platforms, able to service a range of channels, supporting ‘mHealth’ solutions.

Reaching out to people when they are most receptive to change requires careful integration with wider clinical pathways, so that opportunities to engage patients are not wasted. Many early trials have failed to be adopted into a mainstream service because they are seen as a ‘bolt-on extra’ rather than a comprehensive transformation of the care system.

Building clinical leadership around a shared vision is vital to bring about change, and appropriate incentives will be needed for widespread adoption among clinicians.

Fragmentation of healthcare systems significantly slows adoption. Ultimately, it requires system-wide reforms to adjust for the fact that the party that pays is often not one that gains. In the meantime, adoption will centre on payer-provider systems, such as the NHS as well as the comprehensive private systems like Partners HealthCare and Kaiser Permanente.

Building a telehealth service requires a clear vision for growth, an understanding of service maturity to drive improvements and a commercial strategy for moving beyond the limitations of current technology platforms.

Expanding telehealth use in stages is likely to be a realistic approach, with trials in certain conditions or demographic groups being tested first. This will help demonstrate the limits of existing technology investments, and where whole new capabilities would be required.

Innovation will open up new opportunities but will often be constrained by the legacy of earlier technology choices. Organisations investing in telehealth should seek to carry their vision forward into commercial arrangements, ensuring that suppliers remain incentivised to continue to develop solutions. Often the scale of investment required will mean collective purchasing at a regional or national level will be required.

The telehealth vision should also provide the commercial foundations for growth, particularly in building more flexible solutions and fixing a commitment for the incorporation of standards for interoperability as they become available. This will allow operators to be freed from proprietary constraints to provide the sort of integrated services needed to deliver at scale.
Collaboration shapes technology enhancements

New technical and professional standards need to be created in order to open access and enable services to work across organisational boundaries. Governments have to help steer this process in order to provide the scale of customer demand to justify industry investment.

Technical standards that enable different technologies to work together are essential. This offers users a choice of technologies, opening the possibility of developing solutions to meet minority interests and reducing repeated development costs associated with bespoke developments.

The formation of the Continua Health Alliance and the publication of the first interoperability guidelines for personal health and wellness technologies are signs progress is being made on this front.

The writing is on the wall for those suppliers still holding out with proprietary offerings. Adoption will ultimately be supported through effective regulation and incentives, such as the criteria for ‘meaningful use’ that have been incorporated into the US investments in healthcare reform.

The groundwork has been laid for telehealth to play its part in creating sustainable healthcare services.

Delivering on this early promise will mean taking bold steps in building capability and capacity, recognising the limitations of existing technologies and laying the foundations for scalable services.
NHS PILOTS OF TELEHEALTH

The UK’s National Health Service is progressing with sophisticated pilots of telehealth  technology. Its Whole System Demonstrators (WSD) programme aims to gather primary data about the impact of telehealthcare. It is a randomised control trial, and believed to be the biggest telecare and telehealth trial in the world to date.

Three WSD sites - Kent, Cornwall and Newham - were selected in 2007, and have since been involved in detailed planning and implementation.

All three sites have recruited GP practices and participants and are now monitoring participants and gathering data for the evaluation.

Over 6,000 participants have been recruited to the programme, half in the intervention group and the other half in the control group.

The control group will receive usual care for 12 months after which they will receive either telecare or telehealth services depending on their needs.
Case study: diabetes

In east London, Newham Council and  the local PCT are working together on their WSD telehealth and telecare trial. The project is now well under-way, and its co-ordinators say participants are already experiencing the “life changing benefits”  from the new technologies.

Telehealth user Carol Hodges, 58, suffers from diabetes as well as a heart condition which means she has an irregular heartbeat and palpitations.

Carol’s blood pressure often drops very low and the concern for her and her husband is that it could happen quite rapidly with little time to recognise the symptoms.

Using telehealth since January 2009, Carol is able to take her own blood pressure, weight, pulse, blood sugar and oxygen levels each day.

The readings are taken with special equipment which is linked to a set-top box connected to her television.

The results, which Carol can view on her television, are automatically uploaded to a team of healthcare professionals who view them daily.

“Ever since having telehealth, I know what’s happening within my body. Without it I wouldn’t know that my blood pressure keeps dropping…I don’t know what I would do without it,” she said.

Close monitoring has meant that any dramatic changes in the readings of people with conditions like Carol’s, are often picked up in rapid time.

In one instance, Carol was not feeling well and thought she would take her blood pressure to check if it had dropped. It had dropped to 80, which is very low, and she was experiencing extreme shortage of breath.

“I called the nursing team and told them that I was not feeling at all well. They took a look at my readings and said that my blood pressure looked very low. Before I knew it an ambulance was here at my house…If it wasn’t for them I don’t think I’d be here today,” she said.

Tests showed Carol had  high levels of potassium in her blood and was treated and kept in hospital overnight and then discharged the next day.

Carol is now playing a much more active role in the management of her own health and is more conscious of any changes in her readings.

“It has helped me with my weight too. Weighing myself every day really encourages me to keep an eye on my health because I can see my progress. I’ve lost over two stone because it keeps me on my toes to watch what I eat.”

Source: www.newhamwsdtrial.org/telecare

Authors: George MacGinnis is a member of PA’s eHealth team and works within the NHS to develop use of personal health technologies. George is vice-chair of the Continua Health Alliance’s Use Case Working Group, leading work to establish more consumer-ready connected health services.

Henry Rivera, managing consultant, is an expert in Assistive Technologies for Social and Health Care applications, with over 20 years’ experience in the development of IT and Innovation. Over the past seven years Henry’s main focus has been on using innovation to advance the delivery of health and social care across England.

Michael Dillon has supported implementation of the UK’s largest telehealth services. He led the development of standards based information sharing solutions now being adopted across the NHS to support integrated working across services and care teams. He has played a key role in developing the next generation integrated telehealth and telecare solutions­ being proposed by one of the largest solution providers in Europe and in use by some of Europe’s largest providers of health and social care.

The Importance of Telecare in Developing World

The phrase developing world is used to describe nations and
regions that lack basic infrastructure such as improved
roads, municipal power, water, and sewage systems as well
as access to higher learning and healthcare. Typically
these regions also lack robust telecommunications often
relying on poorly constructed terrestrial phone services
and the occasional cell phone network.

While great efforts are made to provide basic services such
and medical care, dental care, and basic public health
services, worldwide resources are spread very thin. In
developing regions, the political, economic, and logistical
hurdles often make access to healthcare nearly impossible.

The healthcare shortages in the developing world directly
affect developed regions of the world. Often, new diseases
emerge first in developing regions. Without proper
surveillance, these diseases can quickly spread and the
concern is that the world will be unprepared for the next
pandemic

New technologies are being deployed today to extend
resources and overcome the logistical problems that hamper
basic healthcare. Telecare is the term used to refer to the
use of technology to remotely monitor patients, conduct
patient examinations, and provide expert guidance to
in-field healthcare workers.

Tools such as cell phones, satellite phones, web cameras,
and video conferencing now allow specialist to consult with
local doctors and aid workers. These same technologies are
also being used to train healthcare workers in the field,
provide epidemiological surveillance, provide mental health
services, and ensure patient treatment compliance.

Technology can also be used to provide preventative
services. For instance, we know that providing prenatal and
neonatal education to parents reduces infant mortality and
can help reduce disease incidence in small communities.
These courses can be developed to be delivered over cell
phones and laptops.

The importance of telecare in the developing world cannot
be understated. Already technology is improving and saving
lives in regions such as Nepal, Western, and Central
Africa. Despite political and economic upheaval, some
regions are finding support from local, national, and
global telecommunication companies. Never-the-less,
equipment and telecommunication services can be very
expensive. In central Africa, a cell phone with a built in
camera may cost as much as two months wages.

In many ways we have reached a tipping point in world
health. We are so mobile and so interconnected that a
disease outbreak in the farthest corner of the world can
reach each of us in a matter of months. Yet, we still lack
the ability to provide basic healthcare to a large portion
of the world's population.

It is vital that developing nations find the resources
necessary to implement telecare services to remote regions.
Doing so will take political and financial commitments from
governments and private industry.

Support from other sectors is critical. Our healthcare
workers will need to be trained to understand and use new
technologies; this presents a new challenge to colleges and
universities. Professional telecommunication workers are
already playing a vital role in healthcare. In developing
regions, they may be as scarce and as valuable as a nurse
or doctor.

New Health And Safety Guidance On Accidents At Work

The Health and Safety Executive, concerned for the safety of ‘lone workers’, has recently published new guidelines for employers that emphasises that out of sight should never mean ‘out of mind’ in a working environment.

The guidance reinforces the concept of the employer’s duty to ensure that lone workers are properly assessed to consider all the risks that are peculiar to a lone working environment. These issues include:

* The fact that there is nobody to report incidents to or to detect fatalities, particularly in high risk areas.

* Omissions on the hand over of duties.

* An increased threat of violence, risk of fraud or dishonest activity.

* Consideration of the impact of a lone worker’s medical condition.

* Risk of employees ‘cutting corners’ or unsafe practices developing owing to a lack of supervision.

* Workers trying to continue operating using defective equipment or work stations.

The HSE considers that lone workers are particularly vulnerable and should be consulted on the assessment. They also emphasise that lone workers should also be fully trained in any areas identified as a potential risk, and that measures should be enforced to ensure that lone workers are not put at risk. These may include identifying jobs that are prohibited when working alone, such as lifting heavy objects or operating at height without adequate safety equipment or an assessment of the situation beforehand.

The greatest issue is the lack of supervision. Obviously, employers have to be able to trust their employees to operate in the safest ways possible, but this isn’t always the case in real life. The lack of supervision also leaves another door open – the risk of fraudulent compensation claims for injuries suffered while working alone. Often, claims result from non-reported accidents at work, and leave the employer at a distinct disadvantage. That is not to say that every claim by a lone worker is fraudulent – what it means is that lone workers often do not have the same ability to report an accident and have it documented in the same way that an accident in a workplace where there are other employees present does. Lone workers don’t have their own ‘accident book’, and one of the most essential pieces of any claims jigsaw is hard evidence.

Although this may seem to put employers on the back foot when it comes to fulfilling their duty of care to lone workers, there are ways that the risk of a lone worker suffering an accident can be minimised. If an employer knows that their workers are going to be operating in a solo situation, a complete risk assessment and (if necessary) controlling measures need to be implemented. If this isn’t done, then the worker has a legitimate grievance in the event of an accident and a claim can and should be pursued. If not just for the financial aspect of the claim, then to prevent another lone worker from suffering a similar fate.

The duty of care responsibilities of every employer extend to all employees in their care, whether they’re working with others or on their own. The HSE has made it quite clear that they will take a strong, disciplinary line with employers who adopt an out of sight, out of mind approach to worker’s safety and that claimants have every right to expect the same treatment in law as those who work in more clearly defined working environments. As the number of people working from home and in solo positions rises, it is an issue that will continue to have the HSE spotlight shined directly onto it.

Dementia and Telecare – free event for north Warwickshire

If you would like to find out more about how telecare could work for you, come along to this free and interactive event in Atherstone.  If you have experience using it at home or have a professional interest, your visit would be very welcome:

Partnership Centre, Coleshill Road, Atherstone, CV9 1BN

Thursday 4th November 2010

from 12.00 to 3.30pm

If you would like to attend, please click here for more details.

http://www.dementiawebwarwickshire.org.uk/news/uncategorized/dementia-and-telecare-free-event-for-north-warwickshire/

Sonim and SafeLinQ Partner to Provide Ultra-Rugged Mobile Phone Solution for Lone Workers in Hazardous or Dangerous Environments

SAN FRANCISCO, Oct. 6 - CTIA - Sonim Technologies, manufacturer of the world's most rugged mobile phones and SafeLinQ, the global leader in Mobile Location-Based Products (MLBS), announce an all-in-one Lone Worker monitoring solution that keeps people safe and connected while in harsh, extreme, and dangerous work environments. To date, the Lone Worker safety solution has been deployed with Emergency Response Centers in Europe and North America  and is being used to protect private and public sector construction workers, gas pipeline maintenance crews and security guards. The solution is also available in the Middle East, Africa, Latin and Central America  and is suitable for Lone Workers that work on oil rigs, in logistics and delivery, on transport tarmacs, in logging yards, in forests and at the scene of floods and fires. 

The Sonim XP3 SENTINEL phone contains embedded software that enables workers in danger to send distress signals like 'FIRE' or 'MAN STUCK' complete with the worker's GPS location to an Emergency Monitoring Centre via GPRS or SMS. The XP3 SENTINEL's long GPS tracking battery life and an ultra-rugged, waterproof shell ensure that the phone is a reliable method of communication every time.

In North America, the emergency monitoring and response service offered with the Lone Worker Solution is provided by the GEOS Travel & Safety Group. Bob Davis, President of GEOS states: "The pairing of the high quality Sonim GPS cell phone with the world class emergency monitoring and response services of GEOS has resulted in a safety and security program second to none. 

Martijn van Bree, CEO at SafeLinQ comments: "Sonim and SafeLinQ have collaborated to provide the world's most rugged mobile phone combined with custom software to communicate with GEOS, the world's most reliable Global Response Centre. The combination of these valuable assets will save many lives over the coming years.

Key functions of the Lone Worker Monitoring Solution include a Man-Down sensor based on a three- axis accelerometer (which detects impact, tilt, free-fall and non-movement) and a dedicated Red Emergency button, operable even when the phone keypad is locked. When the Red Emergency button is pushed, an alarm message is sent to the Emergency Response Centre with the worker's exact GPS location.  Employers can turn the safety service on or off, and set alarm settings, shift times and program intervals when location tracking is active. A status button can transmit an active position or message such as 'ARRIVED AT LOCATION', 'SAFETY RISK' or 'ENTERING BUILDING WITHOUT GPS'. All of these settings can be managed remotely for total flexibility.

Sanjay Jhawar, Vice President and General Manager of Applications at Sonim Technologies said, "Our early customers have told us that the solution is not only easy and quick to setup for new users, but they find that they can use the XP3 SENTINEL with confidence in working environments that caused the screens of other devices to crack, or become unusable through internal dust accumulation or exposure to severe weather."

ABOUT THE XP3 SENTINEL
The Sonim XP3 SENTINEL is a tri-band GSM phone that will withstand 2 metre drops onto concrete in any orientation, can be submerged in 1 metre water for up to 30 minutes, and will operate in temperatures ranging from -20 to +55 Celsius  Notably, it has a shock and scratch resistant Gorilla Glass® screen and meets the military-level MIL-810F certification for resistance to humidity, salt, shock and heat.  It is easy to use – even if the user is wearing gloves or has wet hands - and its 110 decibel speakers can be heard over machinery or sirens.  A complete list of specifications can be found at:  http://www.sonimloneworker.com/product_info.php.

Backing up this performance, the XP3 SENTINEL, like all Sonim phones, comes with an industry-leading 3-year Comprehensive Warranty.  In fact, no technical standard fully captures the endurance of the XP3 SENTINEL, and Sonim therefore tests to its own stringent Rugged Performance Standards (http://www.sonimtech.com/rps.php).

AVAILABILITY
The Sonim XP3 SENTINEL is available in the US through distributor Quality One Wireless and with an MSRP of $525.  Access to the GEOS Emergency Response Centre powered by SafeLinQ's Monitoring System is available on plans beginning from £6.80 per user per month, in addition to applicable mobile voice and data chargers from a GSM network operator. For more information, visit www.sonimtechnologies.com or www.safelinq.co.uk

ABOUT SAFELINQ INTERNATIONAL
SafeLinQ International (www.safelinq.com) is one of the fastest growing providers of location based technology (Location Based Services – in short LBS) in the World. Today SafeLinQ is active in 12 different countries worldwide and cooperates amongst others with South African Police Services (SAPS), O2, Orange, Vodacom, Ministry of Justice in England, Securitas and ADT. Originating as Dutch company SafeLinQ headquarters are located in Utrecht and sales branches in Spain, England, South Africa and Hong Kong.

ABOUT SONIM TECHNOLOGIES
Sonim Technologies (www.sonimtech.com) is the provider of the world's most rugged, water-submersible mobile phones designed specifically for workers in challenging outdoor and industrial environments. Sonim's XP family of rugged phones feature outstanding engineering to meet Sonim's Rugged Performance Standards (for example: impervious to water, 2 meter drops, dust and extreme temperatures).  Sonim's industry-leading comprehensive three year warranty has redefined customer expectations of rugged technology. Sonim provides a suite of high-performance workforce management applications including push-to-talk and lone worker safety services on cellular networks. The company is headquartered in San Mateo, California and offers its products in over 50 countries.

Cirrus wins telecare upgrade programme for Riviera Housing Trust

Cirrus, a leading independent national provider of telecare and security systems, has recently been awarded a telecare upgrade programme worth over £115,000 for Riviera Housing Trust.

A member of Sanctuary Group, Riviera Housing is committed to providing quality housing, excellent services and support to communities throughout the English Riviera towns of Torquay, Paignton and Brixham.

The Torbay-based housing association invited tenders through its procurement framework after deciding it wanted to improve its existing community/warden call alarm services. In particular, it was looking for a flexible telecare-enabled communication system that could work with open protocols backed up by first class customer service support. The solution Cirrus put forward will involve the upgrade of 11 schemes using Tynetec Advent XT, an alarm and communication system designed specifically for grouped housing schemes. The Advent XT also retains the alarm signalling capabilities of traditional warden call systems to ensure compatibility with existing Alarm Receiving Centre’s.

Lorraine Baillie- Riviera Housing's Supported Housing Manager commented: “A key concern for Riviera was working out which systems were going to be the best long-term investment, in terms of ease of maintenance, ongoing support and overall cost. The focus on open protocols was important for us as this means the manufacturers disclose the full technical details of their communication protocols allowing other manufacturers to produce compatible components. This creates the potential for freedom of choice in terms of products, installers and maintainers in the future.”

As well as a focus on cost-effectiveness, Riviera Housing was particularly impressed with Cirrus’ approach to environmental and sustainability issues, disposal, and its plans to re-use equipment where appropriate on other schemes not included within the tender.

Andy Davey, Head of Cirrus, said: “We are pleased to have been selected by Riviera Housing for this programme, particularly with their emphasis on value for money, open protocol standards and after care support. Our focus on investment in our people and providing independent advice to customers played a significant role in winning this contract.”

Telecare Awareness

Specialist equipment and adaptations can make it much easier for you to live independently in your own home. The equipment available ranges from large equipment like stairlifts and hoists to smaller gadgets designed for people with specific disabilities.

Large Items or Permanent Fixtures

If you are physically disabled, and especially if you are a wheelchair user, you may need to get equipment and have permanent fixtures installed at home so that you can live there independently.

Examples of equipment and adaptations include:

stair lifts ceiling hoists powered or manual height-adjustable beds powered leg-lifters for people who have difficulty lifting their legs into bed

You may also need to have adaptation work done in your home – for example, having doorways widened or a ramp installed.

Everyday items to make life easier

A wide range of gadgets and devices are available that make everyday tasks easier for people with specific disabilities. Some examples are:

clamps and holders to keep jars stable so they can be opened with one hand talking kitchen scales for people who are blind or visually impaired alarm clocks that vibrate under the pillow for deaf and hearing impaired people kettle tippers for people who have limited arm strength or restricted movement devices that remind people with memory loss or learning disabilities to do a daily task, for example taking a pill

You may have to pay for the equipment yourself. If a piece of equipment will meet a need the local council has assessed you as having, you can use your direct payments to pay for or towards it.

The Disabled Living Foundation has a large range of factsheets, including a number of factsheets concerning equipment for use about the home.

Telecare and personal alarm systems

Being able to summon help immediately in an emergency is often an important consideration for disabled people wanting to live independently at home. A personal alarm system could be the answer.

Personal alarm systems can take many forms. Some depend on someone to be nearby – for example in another room or next door.

Telecare alarms, known as community alarm services, are very useful for people who live alone. They work through a base unit in your home, which is connected to your phone line. By pressing a button on the unit or on a pendant that you wear around your neck, you are connected with an operator who can arrange the help you need.

Some telecare alarms have movement sensors that can detect if someone has fallen and cannot get up, or leaves a certain area. Those alarms will be activated automatically, so the person does not need to do anything to summon help.

The Disabled Living Foundation factsheet ‘Choosing a personal alarm system’ may help you decide what kind of personal alarm system, if any, is right for you.

Telecare devices that can detect smoke, water flooding, gas leaks, room temperature and more are also available. Many of these can be particularly useful for forgetful people.

The Disabled Living Foundation factsheet ‘Choosing equipment to maintain safety and independence at home (introducing telecare)’ has plenty of useful advice.

Additionally, the Disabled Living Foundation’s ‘Living made easy’ website has a section about telecare. It has free, impartial information about telecare generally as well as about telecare products available in the UK.