Personal Emergency Response System

Produced in cooperation with the American Association of Retired Persons

A Personal Emergency Response System (PERS) is an electronic device designed to let you summon help in an emergency. If you are a disabled or an older person living alone, you may be thinking about buying a PERS (also called a Medical Emergency Response System).

How a PERS Works

A PERS has three components: a small radio transmitter (a help button carried or worn by the user); a console connected to the user's telephone; and an emergency response center that monitors calls.

When emergency help (medical, fire, or police) is needed, the PERS user presses the transmitter's help button. It sends a radio signal to the console. The console automatically dials one or more pre-selected emergency telephone numbers. Most systems can dial out even if the phone is in use or off the hook. (This is called "seizing the line.") Most PERS are programmed to telephone an emergency response center where the caller is identified. The center will try to determine the nature of the emergency. Center staff also may review your medical history and check to see who should be notified.

If the center cannot contact you or determine whether an emergency exists, it will alert emergency service providers to go to your home. With most systems, the center will monitor the situation until the crisis is resolved.

Transmitters

Transmitters are light-weight, battery-powered devices that are activated by pressing one or two buttons. They can be worn on a chain around the neck or on a wrist band, or they can be carried on a belt or in a pocket. Because the transmitter is battery-powered, the batteries must be checked periodically to ensure they work. Some units have an indicator to help you know when to change batteries.

The Console

The console acts as an automatic dialing machine and sends the emergency alert through the phone lines. It works with any private telephone line and generally does not require rewiring. If you have more than one phone extension, a special jack or wiring may be required to enable the console to seize the line.

Emergency Response Center

There are two types of emergency response centers - provider-based and manufacturer-based. Provider-based centers usually are located in the user's local area and are operated by hospitals or social service agencies. Manufacturer-based operations usually have one national center. Sometimes, consumers who purchase systems can choose between provider-based and manufacturer-based centers, but consumers who rent systems from a PERS manufacturer usually must use its national center.

Purchasing, Renting, or Leasing a PERS

A PERS can be purchased, rented, or leased. Neither Medicare nor Medicaid, in most states, will pay for the purchase of equipment, nor will most insurance companies. The few insurance companies that do pay require a doctor's recommendation. Some hospitals and social service agencies may subsidize fees for low-income users. Purchase prices for a PERS normally range from $200 to more than $1,500. However, some consumers have reported paying $4,000 to $5,000 for a PERS. You also will have to pay an installation fee which may cost from $50 to $300.

Rentals are available through national manufacturers, local distributors, hospitals, and social service agencies. Monthly fees may range from $15 to $50 and usually include the monitoring service.

Lease agreements can be long-term or lease-to-purchase. If you lease, review the contract carefully before signing. Make special note of cancellation clauses, which may require you to pay a cancellation fee or other charges.

Before purchasing, renting, or leasing a system, check the unit for defects. Ask to see the warranty and service contract and get any questions resolved. Ask about the repair policy. Find out how to arrange for a replacement or repair if a malfunction occurs.

If a PERS salesperson solicits you by phone, and you are interested in the device, ask for information about prices, system features, and services. You can then use the information to comparison shop among other PERS providers. If the salesperson is reluctant to provide information except through an in-home visit, you may want to consider doing business with another company. In-home sales visits can be high pressure, and the salesperson may urge you to buy before you are ready to make a decision.

Before doing business with companies selling PERS, you may want to contact your local consumer protection agency, state Attorney General's Office, and Better Business Bureau (BBB). Ask if any complaints have been filed against the companies you are considering. You also may want to get recommendations from friends, neighbors, or relatives who use emergency response systems.

Shopping Checklist

To help you shop for a PERS that meets your needs, consider the following suggestions:

• Check out several systems before making a decision.
• Find out if you can use the system with other response centers. For example, can you use the same system if you move?
• Ask about the pricing, features, and servicing of each system and compare costs.
• Make sure the system is easy to use.
• Test the system to make sure it works from every point in and around your home. Make sure nothing interferes with transmissions.

Questions to Ask the Response Center

You also may want to ask questions about the response center:

• Is the monitoring center available 24 hours a day, 7 days a week?
• What is the average response time?
• What kind of training does the center staff receive?
• What procedures does the center use to test systems in your home? How often are tests conducted?

Falls Among Older Adults:

An Overview How big is the problem?

• More than one third of adults 65 and older fall each year in the United States (Hornbrook et al. 1994; Hausdorff et al. 2001).
• Among older adults, falls are the leading cause of injury deaths. They are also the most common cause of nonfatal injuries and hospital admissions for trauma (DC 2006).
• In 2005, 15,800 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized (CDC 2008).
• The rates of fall-related deaths among older adults rose significantly over the past decade (Stevens 2006).

What outcomes are linked to falls?

• Twenty percent to 30? of people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head traumas. These injuries can make it hard to get around and limit independent living. They also can increase the risk of early death (Alexander et al. 1992; Sterling et al. 2001).
• Falls are the most common cause of traumatic brain injuries, or TBI (Jager et al. 2000). In 2000, TBI accounted for 46% of fatal falls among older adults (Stevens et al. 2006).
• Most fractures among older adults are caused by falls (Bell et al. 2000).
• The most common fractures are of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand (Scott 1990).
• Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling (Vellas et al. 1997).
• In 2000, direct medical costs totaled $0.2 billion ($179 million) for fatal falls and )19 billion for nonfatal fall injuries (Stevens et al. 2006).

Who is at risk?

• Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2004 was 49% higher for men than for women (CDC 2005). Women are 67% more likely than men to have a nonfatal fall injury (CDC 2006).
• Rates of fall-related fractures among older adults are more than twice as high for women as for men (Stevens et al. 2005). In 2003, about 72% of older adults admitted to the hospital for hip fractures were women (CDC 2005).
• The risk of being seriously injured in a fall increases with age. In 2001, the rates of fall injuries for adults 85 and older were four to five times that of adults 65 to 74 (Stevens et al. 2005).
• Nearly 85% of deaths from falls in 2004 were among people 75 and older (CDC 2006).
• People 75 and older who fall are four to five times more likely to be admitted to a long-term care facility for a year or longer (Donald et al. 1999).
• There is little difference in fatal fall rates between whites and blacks from ages 65 to 74 &340;CDC 2006). After age 75, white men have the highest fatality rates, followed by white women, black men, and black women (CDC 2006).
• White women have significantly higher rates of fall–related hip fractures than black women (Stevens 2005).
• Among older adults, non–Hispanics have higher fatal fall rates than Hispanics (Stevens et al. 2002).