Serving Seniors with Simple Technology – From Indoor to Outdoor Emergency Support and Care

Carmen Ng
Senior Citizen Home Safety Association

Indoor Emergency Support and Care

In a sudden long-lasting cold spell in the winter of 1996, more than 150 living alone seniors died at home in Hong Kong due to delays in treatment. Such alarming tragedy has moved a number of people’s hearts and motivated them to build a new non-profit-making organization to serve the seniors. Bearing a strong social mission to render peace of mind to the seniors, the Senior Citizen Home Safety Association (SCHSA) (www.schsa.org.hk) was established in late 1996 to render 24-hour indoor emergency support service, the “Personal Emergency Link” (PEL) Service by means of an integrated communication system connected to fixed lines (land lines). SCHSA is a social enterprise financed by donation and fee for services. It is managed by professional social workers with over 300 employees, rendering services to over 150,000 users in the past 15 years. When the seniors pressed for help that required immediate hospital admissions, well-trained operators at the Call Centre would immediately contact the ambulance control centre, giving them all the necessary information, including the exact location of the seniors for timely arrival of the ambulance, conditions of the seniors for triage, etc. Almost at the same time, SCHSA’s IT system would also send the seniors’ health records to the hospitals, helping doctors to prepare for timely rescue before the seniors arrive. Simultaneously, operators will inform their family or significant others the hospitals they are sent, followed by the bed number if they are eventually admitted into hospital wards. As of 30, September 2011, SCHSA has already handled 5.23 million calls for assistance, in which over 279,512 required immediate medical interventions, saving precious lives of thousands of seniors, as well as giving peace of mind to their families.

Emerging Needs of Seniors for Outdoor Emergency Support and Care

Yet, there are still unmet needs! “Mammy, where are you?” – a heartbreaking statement from Madam Wong’s children. Since the missing of Madam Wong, her children have tried nearly every means to find their 70 years-old mother and yet, in vain. Unfortunately, this is not a single case. Even more alarming is the rising trend. According to a Dementia prevalence study conducted by the Department of Health and Chinese University of Hong Kong in 2006, it was found that “among people aged 60 and above, the prevalence rate of dementia increased with age and doubled for every 5 years. While the percentage of people for the age group 60 to 64 suffering from dementia was 1.2%, the percentage increased to 32% for the age group 85 years and above.” A more recent Study in 2008 reported that 8.9% of those aged 70 or above has dementia (Lam et al, 2008)¹. Seniors in their early stage of Dementia often lose confidence in going out after their repeated bitter experiences of getting lost in the streets. Family members also tend to lock their demented seniors at home to prevent them from getting lost.

Besides dementia, having one or multiple chronic illnesses is not uncommon in the aged population nowadays. Many of them are afraid of going out for fear of sudden onset of their diseases, like heart attack, shortness of breath, second stroke, etc.

To extend the peace of mind of the seniors and their families from indoor to outdoor, SCHSA saw an urgent need in providing an emergency support and care similar to PEL in an outdoor environment. So, a brand new outdoor emergency support and care service, the Mobile Link Service (MLS), was introduced in 2008. Being an extension of SCHSA’s existing core service Personal Emergency Link, MLS reassembles the same protocols of PEL with additional features, such as location searching for missing seniors.

Outdoor Emergency Support and Care -- The Mobile Link Service

Mobile Link Service is a 24-hour outdoor emergency support and caring service for the seniors. It is a service integrating the mobile applications with social services, a classic example of ICT application in human services. By using a specially designed one-button Mobile Link Device and via mobile technology, users can easily seek assistance by simply pressing the one and only button to contact SCHSA’s Call Centre for timely assistance, such as immediate medical attention by calling ambulance, calling their family members for bringing them to seek medical consultation, requesting location information for guiding them from places to places in case they lost their directions, etc. The Service aims at empowering the seniors by increasing their independence in staying in the community without premature institutionalization, enhancing social inclusion of the seniors by giving them peace of mind in enjoying outdoor activities, as well as cultivating a sense of belonging in the community and promote an aged-friendly community by involving the public in offering help to senior citizens whenever necessary.

Mobile phone has become a more and more popular means of communications for people nowadays. Yet, many senior citizens still face obstacles in using mobile phones, especially those mobile phones with complex operation modes, marginalizing them from the society. In one of our surveys that has successfully interviewed 515 people aged 60 years or above, 40% of them reported that they were not using mobile phones because they don’t know how to use it. Major complaints include keypads and display fonts not large enough and the functions too complex for use. So, a lot of efforts have been spent to study the user experiences of the seniors and to design an aged-friendly mobile device for use in the MLS service. Borrowing the proven successful user experience from the indoor emergency support service, the PEL service, a simple device with a one and only one button was developed. It has a large panic button for sending emergency support and caring request. There is also a card slide in/out and holding design, allowing the users to put their travel card, favorite photo or anything that will remind them to bring along the device with them (www. Mobilelink.hk).

When in need, the senior can press the button for assistance, requesting the call centre operators to help calling the Police, ambulance and/or their family members for timely assistance. They can also press to request for call transfers to their family, relatives and friends, freeing them from the trouble of remembering their phone numbers or looking into the phone books.

With the assistance of a mobile positioning service that involves both mobile technology and RF transceiver, a location tracking service is enabled to help locating the approximate geographical bearings of the Mobile Link device, together with its moving track, giving good references for identifying the demented seniors getting lost in the street. Such mobile application has been proven successful in our service delivery, especially in a highly populated city like Hong Kong, with lots of high-rising buildings that hinder the effectiveness of GPS. In times of emergency, a very loud emergency alarm with specially produced melody can also be remotely triggered to draw the attention of people around to offer immediate assistance, as well as providing directions to the rescue team for more efficient searching. Community education programs have been done to get people familiarized with the melody. This has proven to be an efficient and cost effective way to supplement the not yet 100% accurate location tracking technologies. Many missing demented seniors have been successfully found when the call centre activated the loud alarm, people around were alerted to attend to the seniors wearing the mobile link device, operators could then talk directly to them, getting the exact location of the seniors. Some people were even kind enough to help staying with the seniors until the police or their family members arrive, making sure their safety.

User Satisfaction Survey

To better understand the satisfaction level of our users and their caregivers, we have conducted a quantitative research by means of telephone survey to collect their views. A sample of 193 users and caregivers using MLS service were successfully interviewed. The findings showed that 88% of them were satisfied with the services. Among all aspects, they were most satisfied with the call centre service (89%). They were particularly satisfied with the courtesy of the call centre staff (89%), user-friendliness of the device (86%) and the capability of the call centre staffs to respond to their needs/enquiries (85%). Regarding the perceived value of the service, 82% of them expressed that MLS has brought them peace of mind, freeing them from the fear of sudden onset of sickness in the street without timely assistance.

Way Ahead

MLS has indeed freed the seniors from the locked door of the houses! With increased independence enabled by MLS, the seniors are empowered and regained their confidences in participating actively in the society, allowing them to lead an active ageing in later years of their lives. They are no longer afraid of going out because of their physical conditions or chronic diseases, allowing them to live happily in the community and fulfilling the “ageing in community” concept promoted worldwide. It is also expected to lessen the chance of unattended deaths outdoor and increase the chance of finding the missing people. The service also facilitated the care of family members, who may be busy at work and cannot take care their aged parents. Thus, help sustaining the family care culture and building a caring community. Our efforts have gained a number of social recognition².

In Hong Kong, the number of people aged 60 or above will be increased from 1.2 million people in mid-2009 to 1.4 million people in 2013, from 17% to 19.7 % of the total population. The current share of this elderly segment having dementia and/or other chronic diseases is amounted to over 60%. We will continuously enhance the functions of MLS to further improve our services to the seniors. Recently, we have added GPS and AGPS to the device to enhance the location search function. We are also adapting the device and service protocols to extend our services to serving other needy segments of the society, like the visually impaired and the mentally handicapped.

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