Buying a personal alarm for someone at home: six questions
Most of the marketing is about the pendant. Almost none of the value is.
- Who physically answers, and in what time? A device that phones a family member who is in a meeting is not a safety system. Ask whether there is a 24-hour monitored centre, what the answer-time commitment is, and what happens if nobody on the call list picks up.
- What happens next? Answering is not responding. Is there an agreement with an ambulance service or armed response? Who has a key? Getting to the door is the part families discover too late.
- Does it work in the garden and the bathroom? Most falls happen in the bathroom, and many happen outside. A base unit with a limited radius around it is a common and expensive disappointment.
- What happens when the power and the network are out? In South Africa this is a weekly question, not a theoretical one. Ask about battery backup on the base unit and whether it falls back to a mobile network.
- Will it be worn? An alarm on a bedside table protects nobody, and a device that is uncomfortable, ugly or shaming will end up there. This is the single largest cause of failure and it is not a technical problem.
- What is the total monthly cost, and what is the exit? The device price is usually the small number. Ask about monitoring fees, contract length and whether the equipment is yours.
What a facility needs instead
In a hospital, retirement village or frail care unit, the answering problem is already solved — there are staff on duty. The problems are different ones, and a consumer pendant solves none of them:
- The alarm must find the person. A resident who falls in a corridor, a garden or someone else's unit is not in the room the button is wired to. An alarm that says only "flat 14" sends staff to the wrong place.
- It must reach the right staff member. Broadcasting to everyone means it is nobody's job. Routing to the nearest available carer, then escalating on a timer to the duty sister and the manager, is what turns an alarm into a response.
- It must survive not being acknowledged. The failure that hurts is not the alarm nobody heard; it is the alarm somebody silenced and then got distracted from. An escalation ladder with timers is the control for that.
- It must leave a record. How many calls, answered how fast, by whom, and what happened when the first responder did not acknowledge. Under section 23(1) of the Older Persons Act, the operator of a registered residential facility reports annually to the Minister on compliance with prescribed service standards and measures to prevent and combat abuse of older persons — and a record beats a recollection every time that report is written.
- It must cover staff too. The same wearable that lets a resident call for help lets a carer alone at 02:00 do the same, which is a direct response to the employer's general duty under section 8 of the Occupational Health and Safety Act to provide a working environment that is safe and without risk to health as far as is reasonably practicable.
That is the system described on our nurse call and staff safety page. The button is the cheapest component in it.
Fall detection: what it really does
Automatic fall detection works by watching acceleration and orientation — a sharp deceleration followed by a period of lying still. It is genuinely useful, and it is oversold with a consistency that should make any buyer cautious.
What it is good at: the case that matters most, which is a fall where the person is unconscious, disoriented or cannot reach the button. That is precisely the scenario a manual button cannot cover, and it is why the feature exists.
What it is not good at: being certain. A slow slide down a wall to the floor may not generate the signature. Sitting down heavily, dropping the pendant, or a wheelchair going over a threshold may generate one that looks like a fall. Every such system trades these two errors against each other — tune it to miss fewer real falls and it will raise more false ones; tune it to be quiet and it will miss more. There is no setting that eliminates both, and any supplier who implies otherwise is describing a product that does not exist.
How to use it properly: as a safety net underneath a button, not as a replacement for one. And in a facility, the false-alarm side has a specific cost worth naming — every unnecessary alarm erodes the staff response to the next real one. That is why sensitivity should be set per resident against a care assessment rather than globally, and reviewed after the first month with the actual alarm log in front of you.
A boundary we hold: a fall-detection or pulse-sensing wearable is a safety device, not a medical device. It exists to make somebody go and look. It does not diagnose, it does not monitor a condition, and it does not replace clinical observation. Anything presented as clinical measurement in South Africa falls under medical device regulation administered by SAHPRA — a different regime with different obligations, and not one we operate in or claim to.
Where the wearable actually fails
After the specifications are matched, three practical things decide whether the system works. None of them appear on a datasheet.
- Charging. A device that needs charging every night will spend some nights on the charger while its wearer is in bed — which is when a large share of incidents happen. Longer battery life is not a convenience feature; it is a coverage feature. Ask what happens when the battery is low and who is told.
- Cleaning. In a care setting the wearable has to be wiped down with whatever the infection prevention and control programme specifies. A band that cannot take disinfectant will either be cleaned improperly or removed. Ingress rating of IP67 or better is the practical floor.
- Dignity. This decides adherence more than anything technical. A band introduced as "so we can get to you quickly if you need us" is worn. One introduced as tagging is not. Under the Older Persons Act a resident of a residential facility has an express right to privacy, and an approach that respects it is also the approach that gets the device worn — those two things point the same way far more often than buyers expect.
What we would ask at a survey
- Where do your incidents actually happen — rooms, bathrooms, corridors, gardens? Cover those, in that order.
- Who is the first responder at 02:40, and who is second when they do not acknowledge?
- What is your current answer to "how long did it take" — and where does that answer come from?
- Which residents does a care assessment call for automatic fall detection on, and who reviews that list?
- Do your staff have a way to call for help that works where they are, not where the wall is?
- What will you do in month two with the alarm log from month one?
Related reading: wander management without surveillance for the resident who leaves rather than falls, POPIA and location tracking for the compliance design, and healthcare and retirement living for the wider picture.
This article is general guidance on selecting and deploying safety equipment. It is not medical, legal or clinical advice.