Equipment to Help with Memory and Safety:

The aim of this factsheet is to provide information on equipment that may help with safety both within your home and when going out. The emphasis is on solutions for people who are forgetful, but some of the suggestions are equally useful to people who are frail, prone to falls or simply at higher risk due to their age or because they live alone. It includes low tech solutions as well as more sophisticated devices.

The information contained in this document is strictly for information purposes only. There are hazards with all equipment and the suitability of any solution is totally dependent on the individual. It is strongly recommended to seek professional advice and assistance before you consider buying any type of equipment mentioned in this Information Sheet.

Assist Ireland has a useful document with the contact details of suppliers of dementia care products. There is a huge range of products available today such as home safety devices, or games and activities, memory and orientation aids to assist and support someone living with dementia. All these suppliers have websites where you can browse their full range of products and buy online.

There are times when many of us momentarily lose track of which day it is but if a person is losing track of the days and missing appointments or not paying bills on time, this is an indication of a significant problem with their memory. There may be other signs such as forgetting names of people in everyday contact, regularly losing items where this was not a problem in the past or a significant loss of weight. These things can be very frustrating and cause anxiety.

If you haven’t already done so and feel that this is a problem or the situation is getting worse, contact your GP, particularly if there are feelings of agitation, anxiety or extreme irritability. A GP can offer treatment advice, information and/or referral to other services. Please refer to the organisations listed at the end of this Information Sheet.

What is a personal alarm system and what is telecare?

Telecare is support and assistance provided at a distance using information and communication technology.

Personal alarm

One of the simplest forms of telecare is a personal alarm (also known as a pendant alarm or a socially monitored alarm). This alarm consists of a button – often in the form of a pendant worn around the neck, or on the wrist, and a base unit that works with your telephone system. Your base unit receives a signal from your pendant and this is linked to a 24-hour, 7 days a week monitoring centre. When you push the button on your pendant, a call will go to the monitoring centre. The base unit is a two way device, enabling you to talk to the staff at the monitoring centre, and for them to talk to you. The staff at the monitoring centres are trained to quickly assess the problem and organise the most appropriate assistance for you. If it’s a false alarm don’t worry, they will be glad to hear that all is well.

Telecare

When a personal alarm system has additional monitors and sensors added to it, it becomes a telecare system. These monitors and sensors ensure the continuous, automatic and remote monitoring of users to enable them to continue living at home, while minimising risks such as falling and wandering. There is a large range of sensors available which can detect dangers such as smoke, carbon monoxide, gas and water overflow, and they can even be set up with medication dispensers which will alert the person to take their medicine and automatically dispense the correct dose each time. This enhanced form of telecare enables usual behaviour patterns to be monitored, and for changes outside of normal behavioural patterns (for example, not getting out of bed at the usual time or leaving the house late at night) to instigate an appropriate action. Telecare monitoring covers a wide range of needs, and is intended to support people and enable them to continue living in their own home, independently or with the assistance of carers, for as long as possible. It also supports carers and families by providing additional help and support and all-important peace of mind.

For details of companies in Ireland which provide these services, see Personal alarm and telecare providers

As explained above, there are personal alarm systems, and if these have additional monitors and sensors, they can become a telecare system. Currently in Ireland, there is funding available through the Seniors Alert Scheme only for a socially monitored alarm or personal alarm system.

This scheme will only provide for the once-off cost of the installation of a personal monitored alarm and will not cover any additional monitors or sensors. It is important to consider the system chosen as you may not need additional monitoring initially, but as time goes by you may need additional support in your home. Your system should be chosen with this in mind. So if or when you need other telecare sensors and monitors to ensure you can remain independent but safe, that these can be added to your existing system as it will be costly to replace your system completely.

It is also important to know if there are additional costs involved if there are additional monitors. Some companies just charge for the purchase of the monitors and there is no increase to the annual monitoring cost of the personal alarm. While other companies charge for the purchase and also increase the annual or monthly cost of the monitoring depending on the number and type of sensors being used.

How to get a personal alarm

The main ways to get a personal alarm in Ireland are:

• from your local authority (if you live in a local authority sheltered housing scheme),
• directly from the manufacturer or supplier (purchasing privately),
• through the Seniors Alert Scheme, a grant support scheme run by Pobal on behalf of the Department of Housing, Planning and Local Government. It is administered locally by local community and voluntary groups.

Manufacturers or commercial firms

Some of the alarm manufacturers sell or rent alarms directly to the public. For details of companies in Ireland which provide these services, see Personal alarm and telecare providers. Age Action Ireland (see Useful addresses) will also supply the names and contact details of commercial suppliers (this does not imply there is any endorsement of the companies or services provided). All Irish suppliers provide their own monitoring service and charge an annual fee for the service.

Seniors Alert Scheme administered by community and voluntary groups

There is a grant available called the Seniors Alert Scheme which covers the cost of buying and installing a monitored alarm system. This Scheme does not provide funding for other safety and security equipment such as external security lighting, internal emergency lights, monitored smoke detectors and monitored carbon monoxide detectors.

To be eligible for the Seniors Alert Scheme you must be:

• aged 65 or over and have limited means or resources
• Either living alone, living alone for significant periods of time during the day, living with someone who also meets the eligibility criteria, or caring for someone else in your household
• living in the area covered by the community group administering the grant support
• able to benefit from the equipment being supplied
• willing to maintain contact with the community group.

The grant is funded by the Department of Housing, Planning and Local Government and run by Pobal. Pobal uses local groups such as the Society of St Vincent de Paul to administer the scheme within the community. You should contact either your local community Garda, or Pobal directly (See Useful addresses) to get the name of the group administering the scheme in your area.

The community group assesses your eligibility for the scheme, identifies suitable equipment, obtains quotes and then submits the application form and supporting documents to Pobal.

(Note: Currently, the scheme also covers the first year’s the annual monitoring fees or maintenance fees associated with these systems.)

Costs

The costs for the alarm system can be divided into once-only costs and on-going costs.

The once-only costs include:

• telephone line and socket (if you don’t have one already),
• new style plug in telephone socket (if you don’t have one already) or, if you have a new style socket, you may need an additional one for the alarm,
• alarm system, if you are buying the alarm outright.

On-going costs include:

• telephone line rental,
• telephone call costs, this will depend on how often you use the alarm system,
• control centre charges per year after the first year.

Private Purchase of Equipment

Private purchase may be necessary if the user is not eligible to obtain the necessary equipment from the local area health services, local authority or qualify for a grant from Pobal. Some people may also choose to buy privately because they want the wider choice of equipment available from suppliers on the private market. If you decide to buy equipment privately it is best to try and compare the different options available first.

Private Purchase – Applying for a VAT Refund

VAT paid on certain equipment which is privately purchased for use by a person with a disability can be reclaimed from Revenue. The relief applies to VAT on the purchase of goods which are aids and appliances designed to assist a disabled person to overcome a disability in the performance of their daily functions. Most aids to daily living and communication aids are included. Goods designed for leisure purposes are not. An invoice clearly stating the VAT content of the total amount paid must be included with the application. Contact Revenue’s Central Repayments Office to request Form VAT 61a (see Useful Addresses), or you can apply online for a VAT refund using eRepayments in Revenue’s myAccount service.

Planning for a safer home

Before considering equipment to prompt, warn or trigger alarms, consider simple solutions that may remove a risk. Some hazards cannot be anticipated, eg the light bulb blowing when you are walking up stairs. Others are more apparent and it is therefore possible to reduce risk or get rid of the hazard completely. Judgement of hazards and perception of risk are often personal decisions. There can be a danger that people will continue to do a task in a certain way simply because it is the way they have always done it. In these circumstances, it may need another person to identify the risk and to help find a less hazardous way to carry out the task. So, for example:

• remove loose rugs as these are a trip hazard;
• make sure stairs are kept clear of clutter and that the stair carpet is securely fixed and isn’t worn;
• make sure lighting is adequate. Fit long-life light bulbs;
• look at the layout of furniture – you may be able to create a safer space by rearranging or reducing the
• furniture in a room;
• use equipment that is designed to provide support, such as grab rails and walking aids, rather than leaning
• on fixtures, such as door handles and towel rails;
• place electrical items near to power points to avoid trailing flex;
• wear good fitting and sensible footwear.

Finding solutions

Potential solutions should be explored as early as possible, although this is not always feasible if the person does not acknowledge or even realise that they are experiencing any difficulties. This is particularly relevant when a person has dementia. Introducing change, whether it is in the way things are done or through using equipment, can in itself pose problems for people who are set in their ways or find it hard to learn new tasks. Change has to be at the right time and at the right pace.

Familiarity with an environment contributes towards a person feeling secure and confident. However, over a period of time people often accumulate a lot of clutter that can increase risk. By simplifying and organising your belongings, the home can become a much easier place to live independently. For a start keep regularly used items close to hand and remove items that are no longer used. Keep essential things where they can be seen to act as a visual prompt – for example medication and house keys.

Basic tips include:

• Having an organised approach to everyday tasks can help to solve some difficulties of forgetfulness and can reduce energy expenditure so that tasks become more manageable.
• Have a daily routine. Doing things in a regular order every day, and having set days of the week for less frequent tasks, can help memory.
• Have a central point of reference, for example a notice board or white board, on which a weekly plan can be displayed and where you can post reminders.
• A checklist can be ticked off as a reminder of what has been done, and also gives feedback and reassurance to family and carers.
• Sometimes it helps to do things as you go along, for example, keep a running shopping list so that as you finish items they are added to the list.
• Avoid getting overtired – you will not function well both in body and mind. There may be times in the day when you can manage better, for example, after medication or first thing in the morning.

Potential equipment solutions will shortly be examined in this Information Sheet, however it is first necessary to consider the ethical implications of some of this equipment and the importance of the users’ views, values and choice.

Ethical implications

There may be concerns about the ethical implications of installing Telecare equipment, and how it may affect the privacy of the individual. Telecare can have substantial benefits, and enhance your safety, dignity and independence. However, like any technology there is the potential for it to be misused. There will be pros and cons regarding any potential solution. The requirements and wishes of everyone involved, particularly you, the service user, need to be respected and every effort needs to be made to ensure all parties understand how the equipment and service will work.

Particular concerns can include:

1. Concerns about the general impact of Telecare on care services and how it may be used to cut back care services and reduce carers personal contact with service users. The amount and type of supervision a person requires should be reviewed regularly as their needs can and will change.
2. Concerns that technological solutions may be installed without fully involving or obtaining the informed consent of the individual/s involved. This can be particularly relevant when the equipment is used to support individuals with conditions such as dementia.
3. Concerns about particular types of Telecare device especially those used for monitoring individuals’ movements, and how they may affect the privacy of the individual. Privacy and freedom of movement in our own homes and in public areas are human rights. Thus there are concerns about the balance between risk and protection and about Telecare being used to impose conventional lifestyles on people, for example, keeping regular bedtimes.
4. Concerns that assistive technologies, including Telecare, may be used to do tasks an individual is still able to do for themselves which may contribute to them losing these skills sooner than would otherwise have been the case.
5. Concerns about the use of computer technologies that rely on sharing and storing information and the need to ensure such information remains confidential, is not misused or negligently passed into the wrong hands.
6. That the devices may make daily activities more complicated or increase an individual’s anxieties that they may unintentionally activate the alarm or damage the equipment.
7. Concerns that the use of Telecare equipment may tend to encourage a one-sided focus on an individual’s problems and not on their existing strengths.

There are no uniform ‘answers’, ‘rights’ or ‘wrongs’. However, it may help to consider the following issues:

• Your personal motivations, perspective and preferences and your involvement in planning the introduction of equipment or changes to existing equipment. Do you understand what the Telecare is supposed to do and the options available? Have you agreed that you would like to try the equipment/service?
• The nature of your disability, for example, is it progressive, or do your needs fluctuate with ‘good’ and ‘bad’ days.
• Your living arrangements, family support and the needs of any carer/s. Their perspectives, personal fears, anxieties and agendas may need resolving as may those of any professionals involved.
• The reliability and safety parameters of the Telecare equipment.
• Does the situation really call for an equipment or Telecare solution? Is there an overreaction to an incident that has only occurred once? Are there alternatives to equipment? Ideally the focus will be on reducing risk, not the person’s freedom to make decisions which may involve risks. For example, if an individual is going out and perhaps getting lost or disorientated then one approach may be a Telecare door sensor, another approach may be to provide someone to walk with them. If they are going out because they are looking for social contact then this will not be resolved by technological solutions.
• How will the usefulness of the Telecare equipment and service be reviewed and evaluated? If you change your mind about having the equipment what will happen?

Day/date and time orientation

Some people have difficulty remembering the day of the week and the time of day, i.e. seven in the morning or seven in the evening, especially in the summer months when there are more daylight hours. Also, confusion can arise in the winter months when the evenings draw in early – it can be dark at 5pm, but it is not bedtime.

Possible solutions include:

• a daily timetable written out by a carer or relative can help by giving structure to the day.
• It could include, for example, visiting times for carers, meal times, and the time and channel for favourite TV programmes. It could be written on a white board, wiped off and replaced each day.
• a wall clock with clear, bold numbers may help with time orientation. Some also show the day of the week and/or date. Some have a symbol for night or day.
• important dates, such as birthdays and doctor’s appointments, written down at a central point of reference such as a white board.
• a calendar with bold script and a clear space for writing. Days can be ticked off before bedtime.

Prompting devices

Prompting devices are available that play a short pre-recorded message when they sense movement. For example, you could place one near your front door, so that when you approached the door it would automatically remind you: ‘Put your safety chain on before you open your door to a caller’ or ‘Don’t forget to take your keys when you go out’. Thus, these devices can provide a useful prompt if you are experiencing difficulty with your memory. However, the maximum message length is quite short; 10-20 seconds on most models.

Devices are also available that automatically display or play messages at preset times. For example, they could remind you at 11.00 every Thursday that you are due to be picked up at 11.30 to go out for lunch.

There are a number of applications for smartphones and tablets, some of which are free, which can be used to remind the user to carry out certain activities, such as taking medication. This might be useful for someone who is already familiar with using a smartphone or tablet.

Taking medicines

It is essential to get medication doses and times right because getting them wrong can affect health and wellbeing. Problems include:

• managing childproof containers
• reading the labelling
• remembering what medication to take
• remembering when it should be taken
• remembering whether it has been taken, and taking a repeat dose/s

Keeping medication where it can be seen easily can in itself act as a prompt to taking it. Tablets can be transferred into a pillbox, a compartmentalised box marked with dosage times. Boxes have a flip lid or a sliding lid that should be easier to open than a pill bottle. The empty compartment provides a reminder that the dose has been taken. The boxes come in a range of complexity. Some boxes just provide for a single day’s medication, others take a full week’s supply of tablets with days of the week clearly labelled. These boxes are sometimes referred to as “dosett” boxes.

The user or a family member will need to be able to transfer the medicines into the dosette box when needed, ensuring that the right medications are inserted for the right times. If a person finds it difficult to load the pillbox, some pharmacists can dispense prescribed medicines into labelled trays (or dosage cups for liquid medication). They may charge for this service.

Pill dispensers with prompts

Pillboxes are available with alarms. This range of pill boxes use flashing lights, alarms or vibration to prompt you to take your medication at preset times. Some people may find setting up these devices complex and fiddly so help from a family member or carer may be needed.

Alternatively you could wear a watch, or use a clock, that allows you to set multiple daily alarms to remind you when your medication is due. You may wish to use this in combination with a dosett box to help organise your pills.

Dispensing pill boxes

Dispensing pillboxes use a mechanism that will physically move the pill compartments so that you are offered the correct pills at the correct time. These units use rotating carousels that require loading with a week or a month’s worth of pills. Different models are available with larger models allowing a greater number of pills or larger tablets to be dispensed. We recommend you consider who is going to load these carousels before purchase. If the dispenser is to be filled by a chemist then you may need to purchase extra carousels so you can have one in use and one at the chemists.

Some medication needs to be kept airtight and is therefore not suitable for use in these dispensers. Check with your pharmacist whether your medication should be stored in pill boxes or other dispensers.

Telecare-enabled pill dispensers

Some models can text or email a friend or relative if the medication is not taken. Telecare pill dispensers may also be available as part of a Telecare package. They will automatically notify a monitoring centre if the medication is not taken.

If you use a smart mobile phone and are confident using apps, you could try a medication reminder app. These can be downloaded to compatible smart phones and are designed to give a reminder when your medication is due. You, or someone you know, has to set the dosage times and names of the medication before the reminders will work. Some give an audible reminder, others just a visual reminder when you check the screen.

For further advice on medication management, such as using dosett boxes, pill crushers, pill splitters and pill removers (they help you remove pills from the blister packs they come in), talk to your pharmacist or read RIDC’s guide Take your medicine – A guide to pill boxes, dispensers and reminders.

Cooking

Timers

A timer can be used to remind a person of the required cooking time. A mechanical timer, which might be more familiar and easier for older people to use, stops when the spring has wound down. An electronic timer might be more difficult to set but may sound for longer, or stop and then sound again after a short interval. Keep the timer next to the cooker to act as a prompt to set it. Some timers have useful features such as large digits or a talking read-out of the remaining time for individuals who cannot see the display.

Electric plug in adaptors are available from high street stores that will automatically turn off plugged in appliances after a preset period of time (e.g. 5 or 30 minutes). This may be a good safety precaution especially for appliances that heat up like an iron.

Smoke and heat alarms

Smoke detectors should be fitted in all households. Ideally, smoke alarms should be mains powered so that their effectiveness does not depend on battery life. For people with a hearing impairment who may have difficulty hearing an alarm, smoke alarms are available that flash a strobe or light. At night some systems can trigger a vibrating alarm designed to be placed underneath a pillow.

Telecare smoke alarms will automatically sound an alarm in your home and send an alarm call to your monitoring centre if it detects smoke. The monitoring centre can then alert the fire brigade. These alarms may be appropriate if you would find it difficult to get out of your home promptly, or might not remember what the smoke alarm was for. If a Telecare smoke alarm is not installed as part of your Telecare system, you should still have at least one working standard smoke alarm in your home which will sound an alarm if it detects smoke but these will not automatically alert your help centre. Smoke alarms are not generally recommended for kitchens as some smoke can be expected from cooking and toasting. Consequently a temperature extremes alarm or heat alarm may be considered. They work by detecting extremely high temperatures and also monitoring the rate of any rise in temperature. As with smoke alarms, standard models are available from high street retailers and Telecare compatible temperature extreme alarms may be available as part of a Telecare package.

Cooking and gas alarms

Many individuals prefer to use gas ovens, and especially gas hobs to electric hobs. However, problems include:

• turning on the gas and forgetting to ignite it;
• leaving pans on that boil over, extinguishing the flame;
• forgetting that foods have been put on to cook;
• old appliances that may be a safety risk.

Leaking gas is dangerous. Ultimately, leaking gas can build up to dangerous levels which can result in explosions. All new cookers and hobs sold in Ireland since 2005 require flame failure devices to be fitted on all burners. A flame failure device is a protective device built into a hotplate, oven or gas burner which shuts off the gas supply when the flame is no longer detected. In this way the device protects against a possible build-up of unburned gas. For example, if the burner flame is extinguished or the user forgets to light the burner, they will be protected. If your cooker or hob was fitted prior to 2005 it may not have a flame failure device on all burners. Older models of cooker may not have this safety feature. One option to manage the danger of un-ignited gas is to fit a natural gas alarm (not to be confused with carbon monoxide alarms) that will sound when the sensor detects gas. Some only sound an alarm, so someone must recognise what the alarm is for and act on it. Others actually turn off the gas supply. Check with your local gas cooker retailer for further information and advice.

Gas alarms can also be linked to Telecare alarm systems. These may be appropriate for individuals who live on their own and may not remember what the gas alarm is for if it goes off. If you smell gas, ring the 24-hour emergency number for Bord Gais on 1850 20 50 50.

In situations where you want to manage when a person uses the gas cooker so they don’t use it when he or she is alone in the house, a gas isolator switch, fitted by a gas safety registered engineer, can be used to turn off the gas supply to the cooker.

Electric cookers and alternative cooking appliances

Microwave ovens have some useful safety features: only small amounts of water are needed for cooking; they cook for a pre-selected period of time; and containers designed for use in the microwave should not get as hot as those in an oven. The drawback is that learning to use a microwave might be difficult e.g. remembering not to use metal or foil containers. Talking microwaves are available, designed to assist users who cannot see the displays by speaking the settings out aloud.

Induction hobs may be worth considering as they often have a timer built-in and they only heat the pan, which means you can touch the adjacent surface without burning yourself. Rather than the cooking surface heating up, a magnetic field is created between the pan base and an element underneath the glass top. However, the saucepans you use need to be induction compatible and induction hobs may not be suitable if you have a pacemaker fitted because of the powerful electromagnetic field. Devices are available to automatically turn off an electric cooker after a certain time, or if a sensor detects too great a build-up of heat.

Electric plug-in adaptors are available from high street stores that will automatically turn off plugged in appliances after a preset period of time (e.g. 5 or 30 minutes). This may be a good safety precaution especially for appliances that heat up like an iron.

Carbon monoxide alarms

Carbon monoxide alarms will sound an alarm if they detect carbon monoxide. Carbon monoxide is a gas which has no smell, taste or colour. It is produced by the incomplete combustion of fuels including gas, oil, coal and wood used in boilers, gas fires, water heaters, solid fuel appliances and open fires. Exposure to above recommended concentrations of carbon monoxide can cause headaches, dizziness, nausea, convulsions and death. Gas appliances that are old or have not been regularly serviced can present an increased risk of carbon monoxide poisoning. A servicing contract would ensure that appliances are checked annually and are in good working order. Servicing companies generally take on the responsibility of contacting their clients when a service is due, making it one less thing to remember. As with smoke and heat alarms, carbon monoxide alarms are readily available on the high street.

A Telecare enabled carbon monoxide alarm may be recommended if you may not remember what a standard carbon monoxide alarm is for, or what action to take if it goes off. For more information, visit www.carbonmonoxide.ie or call 1850 79 79 79.

Water

The bathroom can be hazardous so it is wise to bathe when there is someone else in the house if this is at all possible. Water spills increase the risk of slipping, and a hot, steamy environment can cause light headedness. Should a fall occur behind the door, it will obstruct the door and prevent a helper from gaining access. If this is a risk, consider reversing the swing of the door so that it opens outwards. Do not lock the door, or alternatively fit a lock that can be opened from the outside in an emergency. Take with you a means of calling for help, for example, a cordless phone handset or a pendant alarm.

There is a risk of flooding if a tap is turned on and forgotten about. This water can make floor surfaces slippery and damage your property. Equipment ideas include using a simple replacement sink/bath plug that has a pressure-activated plate that opens when the water level reaches a certain depth. Another device can be plumbed in (you will need a plumber) that will turn the taps off if water starts entering the sink/bath overflow. Alternatively you could install a special tap that will release a timed flow of water like the taps in some public lavatories.

A bath alarm or flood alarm is a battery-powered device that hangs down into the bath and sounds an alert when sensors on the alarm make contact with the water. As with any type of alerting device, successful use depends on the user understanding what the alarm is indicating. These sensors can provide early warning of overflows and leaks that may grow to become a flood. As with smoke, gas and carbon monoxide alarms, flood detectors may, in some cases, be integrated with a Telecare alarm system.

Healthy adult skin requires only 30 seconds of exposure to water at 55 degrees centigrade before third-degree burning occurs. At 70 degrees centigrade, burning occurs in less than a second. Thermostatic valves can limit the temperature of hot water coming from a hot tap or shower. Water temperature indicators can show when the temperature of the bath or wash hand basin is above a safe level by changing colour or giving a reading of the water temperature. They are preset within a safe range which is usually 34-37 degrees centigrade for the bath and usually 42-47 degrees centigrade for the wash basin. When the temperature of the water goes higher than this they may change colour or sound an alarm.

For advice on equipment that can help with getting in and out of the bath, refer to Assist Ireland Information Sheet Equipment for bathing.

Walking about

There are many reasons why you may feel the need to move and walk about more than usual. These may include: a response to anxiety; subconsciously using up energy; to relieve pain or discomfort; becoming confused about time; becoming confused about where you are. This may result in you: walking from an area of relatively low risk to an area of high risk; getting lost or disorientated, especially at night.

There may be safety risks associated with going into particular areas of your home alone particularly if you experience difficulty when walking such as limited balance, for example, out of the bedroom onto the landing where there is a risk of falling down the stairs. Consequently, you may wish to use prompts to either provide reassurance that it is not necessary to get up, to warn against entering a particular area, or against leaving the home. Prompting devices (see above) are available that can be triggered when movement is triggered in front of them. You could, for example, mount one above a chair or next to a doorway.

Alternatively you may wish to use movement alarms, described below, that will alert someone in your home, such as a carer or relative, that you have got up from a bed or chair, or are in a specific area. They can then come and provide assistance. These alarms often consist of a pager that a carer/relative can take with them into another area of your home or garden.

Systems to sound an alert if an individual enters a certain area

This range of equipment is designed to raise an alert if an individual enters a specific room or area of the home. This may alert a carer that the person has moved from, or to, a specific location. Perhaps this would be because the individual needs supervision on the stairs or in the kitchen. The sensor may consist of a pressure mat for use on the floor or a sensor beam/detector. Pressure mats may present a trip hazard if inappropriately positioned. The sensors may use passive infrared movement detectors which detect body heat or use two sensors with a beam between them. If the beam is broken, for example, by someone walking past, then the alarm sounds. Some sensors sound an alarm, or tone, on the sensor itself, others can trigger a pager that can be 100-300 metres away.

Sensors detecting movement from a bed or chair

These sensors have pads which are placed under your mattress or chair cushion and can detect when you’ve left your bed or chair. They can either trigger an alarm immediately or start a timer. If you don’t get back into your bed, or chair, within a preset time then the alarm sounds. Thus if you go to the toilet, or for a quick snack, and return to bed your alarm will not be activated but if you fall and do not get back into bed, the alarm will be raised. The pads usually trigger a pager that can be 100-300 metres away, although some simpler units sound an alert on the sensor unit itself.

Sensors detecting door opening

These sensors trigger an alarm, or tone, when a door is opened. For example, this may be considered if you regularly become disoriented to time of day and leave the house at night thinking it is daytime. The sensor usually triggers a pager that can be 100-300 metres away (although some simpler units sound an alert on the sensor unit itself). Thus a carer or relative could keep the pager by their bed and, if it goes off, come and assist you.

Some sensors attach to the door and door frame, often requiring a couple of screws. Alternatively some sensors are fitted beside the door frame and the user wears a wrist worn device. The alarm only sounds if the individual/s with the wrist worn device goes through the door. As with smoke, gas and carbon monoxide alarms, door exit detectors may, in some cases, be integrated with a Telecare alarm system.

Personal locators for use outside the home

Personal locators are portable products designed to be carried by you when you go out. They enable authorised individuals, such as relatives or carers, to find out your location by logging onto the internet from a computer or smartphone. Most work via GPS (a satellite based global positioning system) and will allow individuals you have authorised to find your location (if you are carrying the device) to approximately 10 metres. They may not be able to find you if you are indoors unless they also contain GSM mobile phone technology.

Several personal locators offer the option of Geo-Fences. This is the possibility of entering a predefined area into the unit. If you leave this area with the unit then an alarm/alert is raised. Depending on the model this may involve designated contacts such as a friend or relative being informed by a text message. These devices will require an ongoing subscription for the service.

You could use a mobile telecare alarm which allows you to contact/alert a monitoring centre at the touch of a button. They can then find your location using satellite or mobile phone technology and contact someone you have nominated or the emergency services. These devices will also require an ongoing subscription for the service.

Night lighting

Night-time disorientation can be difficult. A plug-in night-light can provide a low lighting level without being too bright and disturbing sleep. Many have a light sensor so it will turn off automatically during daylight hours, but come on again at dusk. If the person needs to get up to use the bathroom at night there’s often a reluctance to turn on the main lighting as it can be dazzling, so once again, night-lights can help.

There can be a degree of urgency that requires the person to get to the bathroom within a reasonable time. The route through to the bathroom and back to the bedroom can be defined using progressive lighting – as the person moves from one area to the next the lights ahead illuminate whilst those behind dim. This helps to:

• steer the person to where he or she needs to go;
• steer him or her away from hazards, e.g. the stair head;
• reduce the risk of the person disturbing other household members;
• reduce the need to call for help from a carer.

Cold room temperature

Sensors are available that sound an alarm or text a number if the temperature falls below a certain level. This may be referred to as a hypothermia alarm. This may be considered, for example, if you have a history of turning your heating off and forgetting to turn it on again during cold spells. Telecare temperature extremes alarms can also be used to alert a monitoring centre if the room temperature falls below a preset level. If low temperature triggers the alarm then the help centre may contact you and/or your friends or relatives to prompt you to check your heating.

Home access and security

People who require support to live independently may well have to give access to their home to a range of different people involved in their care, while still feeling safe within their home. For example, daily carers visiting to help with personal care and meal preparation or emergency responders to a Telecare alarm activation.

Problems may include:

• the number of duplicate keys to be cut
• losing keys
• controlling access to the home
• worrying about a potential increased risk from intruders
• keeping the house secure.

Key safe

A key safe is a secure metal box that stores a key, and is designed to be mounted outside by the front door. The safe is opened by a numeric code that must be punched in. A single copy of your key/s are placed inside but can only be retrieved by someone who knows the correct code to open the box. It is up to you who you give the code to and you can change the code as often as you like. Choosing a code made up of familiar numbers, such as a birth date can help someone with memory difficulties to remember it. A key safe provides a useful way of giving access to the home to regular callers, such as carers and relatives, and also provides a ‘spare’ should the homeowner leave the house without the key. Key safes should be installed covertly (e.g. on the wall or near the door they hold a key for, but obscured from view by a bin or shrub) to avoid attracting unnecessary attention to your property. Tests have shown that some key safes are more secure than others which may determine whether they are approved by home insurance providers. Check with your insurance provider if your key safe is approved and meets the standards required under your insurance policy.

Losing keys is a common problem, but having a set place to keep them, such as a hook by the door, may provide a solution. There are also electronic tags that can be attached to keys to help someone to find them when they have been mislaid within the home. The electronic tag is activated by pressing a button on a transmitter remote control, and will bleep.

Opening the door to strangers can be risky. A door viewer, a chain or intercom can provide a way of identifying the caller before the door is opened fully. Memory prompt sensor devices that give a recorded warning could be triggered as you approach the door from inside. For example, it could automatically remind you, ‘Put your safety chain on before you open your door to a caller’.

If you have a Telecare system installed then Telecare buttons may sometimes be placed near the front door. These may be called ‘Bogus caller buttons’ or ‘panic buttons’. This allows you to simply press the button, automatically raising an alarm at your help centre, if you fear that a bogus caller is trying to trick you or break in to your property. The alarm call can be programmed to be silent so that the bogus caller is not aware they are being overheard by your call centre. The call centre can listen to the situation and intervene, perhaps calling the police, if necessary.

Intercom systems

A door entry intercom is a remote way of checking who is at the door before giving access. Intercom systems also enable sound or speech to be transmitted between two or more locations in the same house.

Systems may be mains or battery operated and either interconnected by a wire or wireless. Some only allow one-way communication (user 1 can hear user 2 but user 2 can’t hear user 1) others are ‘two-way’ allowing full conversation. Some have a handset which must be used when speaking through the system, others have a ‘hands-free’ facility. This may allow the station to transmit messages once speech is sensed. If no speech is sensed, the station remains on receive mode.

Video intercoms are available which display a TV image of the speaker, as are intercoms that also control a remote door release. These may be useful if you find it difficult to get to your front door to let callers in. You can check who it is using the intercom or video and decide whether to let them in using your handset.

Telephones

Since the telephone is a vital communication tool providing reassurance through social contact and a way of calling for help, it is important to ensure that it is always accessible. Common problems include:

• reaching the telephone in time to answer it
• managing small buttons
• remembering numbers.

Have your telephone in the room in which you spend most of the time – this is likely to be the living room, and near a chair so that you can sit to use it. Have an extension upstairs so that you do not have to negotiate the stairs hurriedly. Don’t ever rush – relatives and friends should know that it may take you a while to answer the phone and will therefore, leave it to ring for longer. Several big button telephones on the market provide ease of dialling. Most can be programmed to store frequently used numbers, retrieved by one or two key presses. Some models allow photographs or names to be stored on the memory keys which can prompt the user to the location of the various numbers. Telephones with a digital display can help the user to check the number for accuracy after it has been keyed in and before it is dialled. Alternatively, some models will read out numbers as they are dialled so you can check what number was pressed.

Telephones are also available with an amplified ringer, visual flashing ringer and/or amplified speech which may help if you have hearing loss. Many phones are compatible with hearing aids.

Cordless telephones can be carried with you around the home and garden, but must be replaced on the stand regularly to recharge the batteries. If the handset is misplaced, the stand usually has a paging button that will cause the handset to bleep to help you to find it.

Mobile phones provide an extremely portable way of making telephone contact when you are out and about. However, many are small and complex so may not be suitable for people with limited dexterity, vision or memory. Remembering to charge the telephone can be an issue. There are now several mobile phones designed specifically for easier use. They have varied features depending on the model but may include larger keys, direct dial memory buttons, a docking station for charging and clear high contrast screen.

Mobile phones with an emergency or ‘panic’ button are also available. Pressing the emergency or SOS button will call a series of preset numbers until it receives a response. These systems have the advantage that they may work outside of the home but they have the additional limitations that they will not work if the mobile does not have reception, or has a flat battery. They also require an ongoing contract, or regular topping up of pay-as-you-go credit.

Pendants, pagers and autodialler alarms

The anxiety caused by not being able to get help if something goes wrong, can limit activity and have an impact on independence. An intercom, pendant and pager or alarm provides a way of calling for help.

One-way intercoms (also called baby alarm) enable sound to be transmitted in one direction. For example, they enable you to hear when your child is crying. Some of these monitors incorporate a vibrating pad or pager and/or a flashing light for parents who are deaf or hard of hearing. The vibrating pads can be placed under your pillow at night time. Some also have a visual sound level indicator – e.g. rows of light that increase as the sound the person makes increases.

These intercoms are also available with two-way communication allowing for room-to-room conversation. Intercoms can be used to monitor someone’s activity, but should not be used in situations where they invade his or her privacy.

Short range pendant alarm buttons that signal to a portable pager receiver can give a carer more freedom to move around the home and garden. If the button on the pendant is pressed the receiver may sound an alarm or vibrate to alert the carer. These are designed so that the user of the button can signal to the person with the receiver that they would like assistance. Some systems have a fixed transmitter, like the nurse call buttons by hospital beds that are fixed to the wall. Some have a non portable receiver such as a box that plugs into the mains with an alarm and/or flashing light. However the majority of systems now have a portable transmitter and a portable receiver like a pager that beeps and/or vibrates when the pendant alarm button is pressed.

The maximum range between the pendant and the pager varies between models and will depend on how your home is constructed (e.g. how solid and thick the walls are) but most systems have a range of between 100 and 400 metres. The pendant can usually be worn around the neck or on the wrist. The pager signal is usually a buzzer, vibration or tune.

Check that you are able to operate the alarm button easily, that the signal reaches as far as the likely locations of the receiver (e.g. the garden or an upstairs room) and that your carer can hear the alarm signal.

Autodialler alarms ring a preset series of numbers to friends or relatives when you press a button on a pendant. Most autodialler alarms have a portable pendant transmitter that is worn around the user’s neck or wrist. When the pendant button is pressed it sends a radio signal to a table top alarm unit placed near your phone socket. The unit will automatically dial several numbers in turn (which you have preset), until it receives a response. These numbers could be for relatives or friends and a combination of mobiles and landlines. Programming to dial more than one number increases the chances of the call being answered. You should not programme the unit to call the police, a doctor or anyone else without their prior permission.

There are significant limitations of autodialler alarms compared to Telecare systems that connect to a 24-hour monitoring centre and can guarantee a response 24 hours a day, every day. The individual relatives and friends whom the autodialler rings are unlikely to be able to answer their phone 24 hours a day, they may not always have mobile phone reception, and they may not be available to act immediately. Autodialler systems also tend to have fewer automatic checks to alert you, or someone else, if something goes wrong. For example, they may not warn anyone if they are disconnected from the phone line, the mains electric, or if the battery in the pendant starts getting flat. These are standard safety features in Telecare systems.

However if the system does get through to one of your contacts you know they will be a familiar person who knows your situation. You do not need to pay an ongoing weekly or monthly charge for the service (you do need to pay your standard line rental charges to keep your telephone line). Thus they may suit your needs if you live alone, or spend time alone, and would like to be able to get in touch with friends/relatives who live locally with one push of a button, but don’t anticipate emergencies where an immediate response is critical.

Mobile phones are now available with an emergency/panic button that will call and/or text a series of numbers. Some of these mobiles can automatically include your location in the text messages they send when you press the emergency button. As with the autodiallers these have significant limitations as there is no guaranteed response and the button will not work if the mobile battery is flat or it has no reception.

For more information, see the Assist Ireland Information Sheet Personal alarm systems and telecare and visit Personal alarm and telecare providers for the contact details of personal alarm services.

Emergency medical & personal information

Emergency identification devices include pendants and bracelets which carry vital details of your identity, medical condition and contact telephone numbers. They are designed to be worn whenever you go out, or carried in a purse or wallet. The details they carry may be very useful if you have an accident or become confused or disorientated and require assistance.

A PIP (Personal Information Pack) is a simple initiative to encourage people to keep their personal and medical details on a standard form and in a common location – the fridge. This can save the emergency services valuable time in an emergency. In order for emergency staff and GP’s to identify home-owners with PIP, there will be a green sticker on the inside frame of the hall door.

The benefits of using a PIP are large. From a GP perspective, it means that if called to the care of a patient whom they don’t know, that they can retrieve the PIP from the fridge to ascertain a medical and medicines history. Fire Fighters, Gardaí and Ambulance Staff may also retrieve the PIP from the fridge to discover the person’s history and, in turn, they may bring the PIP to the hospital, should the person need hospitalisation. This means that when the patient arrives in the Emergency Department, staff will have some knowledge of the past medical and medicines history of the patient, along with personal information regarding carers, next of kin, allergies, donor information etc.

The packs are available from pharmacies and are usually free of charge, or there may be a €2 charge. Alternatively, contact your local Lions Club www.lionsclubs.co which distributes containers for the Message in a Bottle scheme in the UK and Ireland, similar to the PIP.

Useful addresses

• Age Action Ireland
  30-31 Lower Camden Street
  Dublin 2
  Tel: 01-475 6989
  Email: info@ageaction.ie
  Website: www.ageaction.ie

• Pobal
  Seniors Alert Scheme Unit
  Holbrook House
  Holles Street
  Dublin 2
  D02 EY84
  Tel: 01-511 7222
  Email: onlinesupport@pobal.ie
  Webpage: www.pobal.ie

• The Alzheimer Society of Ireland
  National Office
  Temple Road
  Blackrock
  Co Dublin
  Tel: 01-207 3800
  National Helpline: 1800 341 341
  Email General: info@alzheimer.ie
  Email Helpline: helpline@alzheimer.ie
  Website: www.alzheimer.ie

• Family Carers Ireland
  Market Square
  Tullamore
  Co Offaly
  Tel: 1800 24 07 24
  R35 PW50
  Email: reception@familycarers.ie
  Website: www.familycarers.ie

• Dementia Services Information and Development Centre (DSIDC) (Provides professional education, training and research in dementia and to those involved in the delivery of dementia care)
  Top Floor
  Hospital 4
  St. James’s Hospital
  James’s Street
  Dublin 8
  Tel: 01-416 2035
  Email: dsidc@stjames.ie
  Website: www.dementia.ie

• Association of Occupational Therapists of Ireland (AOTI)
  Office 1 & 2
  1st Floor
  Haymarket House
  Smithfield
  Dublin 7
  Tel: 01-874 8136
  Email: info@aoti.ie
  Website: www.aoti.ie

• VAT (Unregistered) Repayments Section
  Revenue Commissioners
  FREEPOST
  Central Repayments Office
  M: TEK II Building
  Armagh Road
  Monaghan
  Tel: 047 621 000
  LoCall: 1890 60 60 61
  Email: cromon@revenue.ie
  Website: www.revenue.ie

• Disabled Living Foundation (DLF) (UK charity providing advice and information and a comprehensive up-to-date database of disability equipment available in the UK)
  England
  Tel: 0044 207 289 6111
  Email: info@dlf.org.uk
  Website: www.dlf.org.uk

• Research Institute for Disabled Consumers (RIDC) (independent research body in UK which produces guides for older and disabled consumers based on professional research – formerly known as RICA)
  England
  Tel: 0044 207 427 2460
  Email: info@ridc.org.uk
  Website: www.ridc.org.uk