Pendant alarms and sensors: what they do, and what they cannot do

The pendant is a small waterproof button worn on the wrist like a watch or on a cord round the neck. The base unit sits in the hall or the living room, plugged into the mains and, on older systems, into the phone socket as well. Pressing the button opens a call through that unit, and because it has a loudspeaker and a sensitive microphone, your relative can be heard and answered from the floor of another room. The NHS guide to personal alarms, monitoring systems and key safes describes the same basic types.

It cannot help if it is not being worn. The reasons people give are ordinary ones: it was taken off ready for bed and left on the bedside table, or it feels like an admission that things have changed. The bathroom and the landing at night are two of the places falls happen, so a pendant that comes off at bedtime is missing the hours it is most needed. Ask for a wrist-worn, waterproof version.

It cannot help if your relative cannot press it. A stroke, a faint, a bad bang to the head, or dementia that has gone far enough that the button no longer means anything, all end the same way. If any of those is likely, an alarm is not the safeguard it looks like, and the answer is somebody being there rather than a better device.

It does not shorten the time on the floor by itself. The call is answered in a minute or two. What takes the time is somebody travelling to the house and getting in, which is the whole reason for a key safe. Time on the floor is what does the harm after a fall: dehydration, pressure damage, cold, and a higher chance of hospital rather than home. There is more in after a fall: the checklist.

An alarm answers what happens once something has gone wrong. A visit answers the days in between, because a carer comes whether or not anything has happened and notices what comes before a fall: the slippers worn smooth, the cold cup of tea, the new tablet that makes her dizzy standing up. If that is the half you are missing, you can search for carers near you and compare their rates. An hour every morning is seven hours a week, £126 to £175 at the rates carers charge here, against £28 to £35 an hour at an agency. What hourly care costs compares them.

Fall detectors look for a sudden change of height, then an impact, then no movement. That is what a fall looks like in the data, and it is why the edges are blurred: somebody sliding down a wall may never cross the threshold, while a pendant knocked off a table can. One published test ran thirteen detection methods against falls recorded in real life rather than acted out in a laboratory, and the methods that worked on acted falls did much less well (Bagalà and colleagues, PLOS ONE, 2012).

Key safes are the cheapest part of all this, and the part that decides how long somebody waits on the floor. Look for one carrying the police preferred specification through Secured by Design, which means it has been attack tested rather than sold as secure, and tell the home insurer it is fitted.

GPS trackers raise a question the other devices do not, which is consent. Under the Mental Capacity Act 2005 an adult is assumed to be able to make their own decisions, and a decision taken for somebody who cannot must be in their best interests and the least restrictive option available. A tracker that keeps your father walking to the shop is a different thing from one that settles the family's nerves. If walking out is the worry, read wandering and leaving the house and fill in a Herbert Protocol form with the police in advance; Dementia UK explains what goes on it.

You can find the right council through apply for a needs assessment by social services on gov.uk, which asks for a postcode and gives you the number to ring. It is the same assessment that leads to help at home, and how local authority funding works explains what happens after it.

On charges, the rule is narrower than families expect. A council may not charge for community equipment, meaning an aid or a minor adaptation to the property costing £1,000 or less, and it may not charge for reablement in the first six weeks. That is set out in regulation 3 of the Care and Support (Charging and Assessment of Resources) Regulations 2014. A monitoring service is not an aid, so councils do charge for it after a financial assessment. Ask which part of the offer is equipment and which part is the service.

The switch itself is not something to be frightened of. A digital line carries the call over the broadband connection instead, and units built for it work perfectly well. The risk is an older unit, bought years ago and sitting in the hall, on a line that gets upgraded without anybody joining the two facts up. Government has published the position in the transition from analogue to digital landlines, the dates in the connectivity timeline, and the protections for telecare users in the Telecare National Action Plan.

On VAT, an emergency alarm call system designed to be operated by a disabled person is zero rated when it is supplied to that person for their own use, and HMRC's notice says the monitoring centre's service is zero rated too. You claim it by signing a short eligibility declaration the supplier gives you. The test is a long-term condition with a substantial effect on everyday activities, set out in reliefs from VAT for disabled and older people.

If money is the obstacle, check Attendance Allowance first. It is not means tested, and it is paid at a lower or a higher weekly rate depending on whether help is needed by day, by night or both (gov.uk). Our guide to claiming Attendance Allowance carries the current rates and goes through the form.

You can check whether a provider is certified against the Quality Standards Framework, the audited standard for this sector, on the register kept by TEC Quality. Age UK's advice on telecare is a good second read, and for the house itself there is our downloadable guide to reducing risk at home and home technology that helps at night.