A telecare device that may solve the ‘soft fall’ and unconscious problems (UK)

click to enlargeGuy Dewsbury of the eponymous Gdewsbury independent research consultancy brought to this Editor’s attention his recent commission for West Yorkshire-based MonitorGo in evaluating their new smartphone-based personal alarm. He analyzed the device’s features here in a comparison chart and writeup, versus what is commonly available in the market. If it reliably does what it says it does (our normal caveat), it could be a big step beyond the Ur-Pendant, addressing our (and Neil Versel’s) concerns earlier this week on the persistence of ‘ancient history’ PERS [TTA 31 Mar].

It goes well beyond common mPERS as well. There are 12 features, including GPS location, hard fall detection and 24/7 third-party help line monitoring (via Medvivo), but the key differentiating features are the soft fall detector, unconsciousness/inactivity detection and false alert detection/response–as well as usability as a simplified smartphone with unlimited calls to UK landlines and 250 mobile-to-mobile minutes. This Editor looked back on the promise–and disappointment–of O2’s Help at Hand, which happened around the time that MonitorGO was started in 2013; perhaps the latter is what we in the industry had hoped the former would be. A second caveat is cost: at £199 for the device plus monthly charges for airtime and the help line, it is ‘top end’ pricing. We wish them the best as MonitorGO is officially launching (along with joining the TSA and UK Telehealthcare) and trust we’ll hear more from them soon. (The website is unusually full of information including videos, along with the founder’s personal story, their ethical vision and this blog item profiling Guy Dewsbury.)

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Comments

  1. I welcome any new product used as part of a service that helps to empower people to improve their lives and increase their independence by accepting and embracing smart devices and systems.

    My concern is that manufacturers may offer the impression that a single device is all that is needed, when it is apparent that most vulnerable people have a whole range of issues to be addressed before they can overcome the challenges that old age can put in their way, whether they are sensory, cognitive, physical, neurological or emotional in nature. It follows that assessments need to look more holistically at these issues, and perhaps focus less on unmet needs and risks to independence and social exclusion. The result is likely to be a shopping list of potential technology options – and a responsibility to ensure that the solutions will work together in a wrap-round service that is more than reactive – and that is likely to mean a need for more assistive devices that prevent accidents and adverse incidents such as falls, and which go beyond the simple detection of the accident.

    I suspect that simple check-lists may not be the answer to assessment and prescription; they are necessarily created to emphasise the benefits of one type of device, and must therefore exclude many other relevant factors including, for example, several elements of usability including the need for programmable options to cover parameters such as shock, speed of descent, period of inactivity and wearability (and the effect of location).

    My opinion is that a single device may offer benefits associated with value for money and convenience, but that generic approaches fail to appreciate the variations in individual concerns, and the increased confidence that may be provided by having several separate devices each dealing with one or two different issues. Some may be carried on the person, and may be ideal for a M-care approach, but others could be embedded within the fabric of the home, enabling more of the Activities of Daily Living to be monitored and used to predict decline and the need for intervention. The fact that many of the most vulnerable people in society are effectively housebound, unless taken out by a relative or friend, is a major reason why M-care has not yet totally replaced conventional telecare services.

    It remains to be seen how successful discrete devices (and there are already lots of them in both the falls and the GPS space) will be when they come up against the latest smartphones that have been loaded with a multitude of apps, each capable of addressing several of the issues of relevance.

    Personally, I believe that the need is for excellent services that will both understand what is needed and will offer choices, and a range of solutions. New products will need to evidence how good they are (compared to rivals) in order to fit within a quality framework.

  2. Donna CusanoDonna Cusano

    Kevin, I agree with you that any device should be assessed in terms of a total framework of caring for an individual. That to me is the ideal. We are, I believe, well past the point of every developer claiming at buzzy cocktail parties that their device or app is the one that will revolutionize healthcare delivery, safety etc. MonitorGO happily doesn’t make such claims.

    However a lot of families either can’t access that ‘total assessment’, don’t want to, don’t need to (because the older person is in good shape), it happens suddenly after a hospital stay, or have family dynamics which make it difficult to. When it comes to parents, there’s often a certain state of denial (on both sides) and disconnect. Here in the US, we also have a horrendous shortage of geriatricians, and a lot of disconnect between doctors in our healthcare system, even with Medicare.

    A device such as this, which adds in some important alert capabilities, solves a problem. It is also a phone not a stigmatizing pendant, thus more acceptable. Like you, I would love to see it more customizable for the individual–example, for a heavy person or for those with poor leg function, who typically may sit down heavily or suddenly in a chair, that it doesn’t ‘read’ as a fall or slump fall.

    The fact that they (and GreatCall as well) simplify the smartphone part is to accommodate older people who would find it confusing, or who have vision or motor problems that would make a normal smartphone difficult to use. Who would have thought it plausible only two years ago, when we were all thinking that people over 75 would NEVER accept a smartphone?

    The drawback, of course, is that it has to be carried. But there are a lot of traditional PERS base units that act as paperweights and pendants that sit on the bedside table (about 2/3 are not worn when an incident happens). I also believe that passive sensor activity monitoring should be part of the home (after all, I worked for QuietCare in its early days) but that is another bridge that most families don’t even realize is there.

  3. Hi Donna
    I think that we are in agreement on just about everything – which is indeed a rare things these days!
    I take the view that we (and dare I immodestly suggest that there are relatively few of us in the world?) who know the limitations of the technologies and the systems, have a responsibility to help the public find the devices and the services that are best suited to their actual needs and lifestyles. It does mean recognising true innovation and service quality when we see it, but also having the guts to occasionally provide a reality check when organisations get carried away with the potential of their latest device, and how it is going to revolutionise the lives of so many people.
    We have come a long way in 20 years – but we are still some way off ensuring that vulnerable people get the services that they need to overcome the challenges that life throws at them. – the significance of a brilliant all-singing, all-dancing fall detector can be rapidly relegated if there is no access to a pick-up service that can gain access to a property quickly (and without having to bash down the door), and if the responder doesn’t carry an inflatable cushion.
    Personal budgets and changing eligibility criteria will increase people’s ability to make their own decisions regarding how they wish to receive support in the future. It should mean that more people will be empowered to take the technology options that can be with them 24/7 – but there’s a real danger that they many will make the wrong choices, either because they are looking for the lowest price option, or because they put aesthetics before functionality, and simply don’t consider practical issues such as maintenance and the service requirements. T-Cubed’s Telecare Electronic Prescription Tool (EPG) has supported professionals in recommending solutions for a number of years. Fortunately, its successor – Vivo – which has been produced in conjunction with the Mi Liverpool (DALLAS) team – will be accessible to everyone, and should help individuals and their family carers to find the most appropriate items of Assisted Living Technologies, and the services that can provide them. Of course, there is no guarantee that the items used within a service will be used any more appropriately than PERS pendants, hearing aids or walking frames – but at least the equipment will have been selected and not provided!

  4. lisa black

    I really like the device, however agree with Kevin that we need to look at the fabric of the property to provide this type of technology and monitoring rather than multiple devices. But we also need to look at the gap between inside the home and when someone leaves the home. My concern would be as with most tracking devices, the battery life? due to the constant sending of locations it uses battery very quickly. With this type of device it is dependent on the user ensuring it is always charged. Again working for those who have full capacity, dexterity etc.

  5. I don’t understand your article on this device.
    This is not really a dedicated device it is just a smartphone probably an android smartphone that as been customized and supplied with some applications.
    Do you really think that it is replacement for a pendant telecare ?
    The “independent comparison” is also a joke
    Try this criteria if you want some red crosses : size, ergonomy, autonomy, waterproof…
    I would really like to see how they avoid false alarm and how long it takes to raise an alarm for a standard telecare user with this “device”.

    • Donna CusanoDonna Cusano

      Hubert, I’ll address as from your email domain (which I can access as EIC) you are in the field in France.

      1) Yes, quite true, it is a smartphone with apps, and it is larger than a pendant and as ‘waterproof’ as any smartphone, which is to say not much, so don’t take it into the bath.

      2) As smartphone based, it has been heavily adapted to use smartphone capability, e.g. accelerometer, and the apps are primary, not secondary in the use of the phone. So while it retains internet and phone capability, the smartphone becomes a much more capable device. This is the trend in the field, where you have tablets becoming telehealth devices, replacing the tabletop hubs, simplified phones becoming mPERS (GreatCall 5 Star), older smartphones becoming imaging devices (store and forward images for wound management) and the smartwatch as form factor for alert devices.

      3) A replacement for the pendant? Pendants have multiple drawbacks, notably passive fall detection and that they only work in the home (traditional PERS). As I noted in the article, for more active older people a smartphone form factor and capability is a far better alternative as it matches their lifestyle. Step outside, traditional PERS doesn’t work–and that can be picking up the mail.

      4) Pendants are also stigmatizing as ‘that’s for old people’, in the words of the ADT commercial (US). There are many people in the ‘shoulder’ group who are active, but because of heart and/or other problems, need a way that they are reachable and can alert if there’s a problem. Smartwatches like UnaliWear are another alternative, which may work for some (and be hard to use by those with motor difficulties).

      5) Guy Dewsbury is a well-respected UK consultant in the telecare field, and before publishing I questioned him on the findings. You will note that his commission is disclosed and also his comparison only extends to features. He is yet to trial the unit. However the website seems to bend over backwards with feature disclosure. Notably, the website is not flashy and leans heavily on personal stories and demonstrations.

      6) I would very much like to have in vivo feedback on the performance of MonitorGo. Stephen Bradbury is the founder/CEO and is likely reachable via the phone on the website or through Guy Dewsbury.

      Hubert, I hope this answers at least some of your considerations.

  6. Hi, I appreciate that I’m a little late to the party; and I am also in total agreement with all of the comments. I should also declare that my company has a vested interest as a technical service provider within the assisted living and wellbeing sector. I have a few main points to raise:

    First – the use of a smartphone is entirely logical; the technology (eg location; accelerometer; communications) within the smartphone is far superior to anything currently being manufactured as a ‘telecare’ device; and the location can be used as part of the risk assessments and monitoring.

    Second – The use of a GSM device (the smartphone) opens the device to become more ‘acceptable’ for end users. It doesn’t look like ‘an old persons pendant’ and enables use outside of the home and within a wider area – this will improve ‘adoption’ – it becomes part of the ‘keys, phone, wallet’ routine as you leave home; it empowers social inclusion – and of course will mean the wellbeing of the individual could be sustained for longer – fundamentally enabling them to remain independant within their own home for longer.

    Third — Kevin makes valid points – we acknowledge that smartphone solutions are just a part of the equation. Also, as conditions progress, the needs of the individual changes. Service providers need to offer alternative device choices and other sources of data should be included within the assessments. Our own solution includes device migration plans and integrates activity monitoring within the home.

    Fourth – resilience is also a key factor. This is a product that is ultimately designed to save a life. Testing needs to be thorough and carried out by recognised professional bodies. It will take more than a shiny front end and a glossy web site to convince the police to turn up!! They will expect certificated standards.

    Fifth – Battery is important. A smartphone will eat battery if it’s expected to use the GPS and if it’s also being used for eMail; text; and calls then the customer will be unhappy very quickly.

    Six- and finally – the biggest issue of course is costs. There are lots of start up businesses; app developers etc out there. They all seem to want to charge a small fortune for an App in a market that perceives these to be free! Then they expect the consumer to hand over their cash to an unknown start up? Only an established provider with an existing scale can truly provide the comfort the consumer will desire.

    Just my tuppence!

  7. Thanks for all the comments. It is great that the piece causes a debate, which is really healthy.
    I think that Kevin and Tom bring up some excellent points which I agree with. My purpose for the article is to point to an innovation which is a novel way of doing something and thinking about it. I do not see a smartphone being the answer for everyone and certainly for many it will not be the answer, but we are heading to a place where wearables and smart phones are being used in a more ubiquitous fashion for health purposes.

    When people rethink common problems it creates a market potential. I agree there are a plethora of apps out there that will send emergency alarms and people can use their GPS based phone to locate a person, with the correct software, but I stand by the fact that the MonitorGo phone is a real innovation and something to consider in the repertoire of devices available. It is an innovative way of using a phone to detect soft falls, which up until now have been largely ignored by fall detector manufacturers.

    I suspect in the next few years, As Kevin has highlighted in his own article on TTA that wearables will be used to a greater extent and having a watch that can tell the time and sense when a person is falling off a chair, or can tack them when they are lost will be the future of telecare. Sadly there is a lot of work to do on wearables before this stage is reached. In the meantime the smartphone is an great medium to use to destigmatise telecare and bring it to people who would not use it previously.

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