old couple holding hands

On a chilly, snowy day a few weeks ago, Tyrell’s grandmother slipped on the icy sidewalk outside her apartment and fell. Thankfully, a neighbor soon found her and she didn’t have major injuries. But this wasn’t the first time the 70-year-old had fallen.

Ten years ago, she fell down the stairs and was unconscious for three hours. She’s been dealing with back pain and other lingering issues since, and Tyrell has been trying to help her live as independently — and safely — as possible. He helped her move to a one-story apartment, installed handrails in her tub and gradually moved in with her nearly full-time to help with day-to-day tasks.

Ever since that first fall, Tyrell, 27, has been trying to find a medical alert device for his grandmother so she can call for help if she needs it. But he found it’s not as simple as just buying the right product. (He spoke on condition that the family’s last name not be used to respect their privacy.)

“We tried LifeAlert — you know, you wear the necklace — but she doesn’t want to do that,” he said in a Zoom interview. “Then the bracelet — no. Having her phone with her, even, it’s not always a priority, unfortunately. So I’m trying to find a device that’s simple enough to use, but also one that she’s willing to use and one that’s readily available if she forgets. That’s been a challenge.”

A growing number of Americans are finding themselves in a similar predicament: older adults are increasingly at risk of falls, according to a new study. Hip fractures and other injuries from falls affect 4.5 million people per year. Some people with cognitive decline can wander away from home. Older adults and caregivers may consider buying a personal emergency response system (abbreviated as P.E.R.S.) or medical alert device: a button or a wearable pendant that one can press to call for help in the event of a fall, or if someone has left home without supervision.

But as with much of health care, there’s a dizzying array of devices and billing plans from a myriad of profit-driven retailers. Plus, finding the best technology is only part of the equation when you’re looking to integrate a new tool into an older loved one’s life — it’s not as easy as pressing the button.

This article is based in part on data collected by a team of ClearHealthCosts researcher-reporters in a survey of health-related costs for the care of older Americans, in the Detroit area and beyond, in February and March 2022. Here’s what we learned about medical alerts systems to help you navigate these decisions.

What is a P.E.R.S./medical alert device anyway?

When you think of a medical alert button, you probably think of LifeAlert, the company with the catchphrase so iconic that it has its own Wikipedia page: “Help, I’ve fallen and I can’t get up!” But the market is evolving and at ClearHealthCosts, we priced a variety of medical alert systems from a number of retailers. The idea is generally the same — hit a button in case of emergency and get connected to help, whether that’s 911 or a responder in a call center.

A typical medical alert package includes a base device for inside the home and a second, wearable device or wall button that can be placed in a high-risk area such as the shower. The base could require a landline to hook up or could rely on cellular data networks. Plans for cellular devices typically cost a bit more.

Many packages include 24/7 monitoring, which means your device will call the company’s monitoring center when you hit the call button. You speak to them through the device, or if you’re unable to speak, the call center has your necessary personal information that can help them determine a course of action, such as calling 911. These devices are referred to as “monitored.”

There are also “unmonitored” devices, which typically require a landline connection and will only dial 911 directly or a preset personal contact. We found that these devices are generally a one-time cost. But with monitored devices, you’ll encounter a variety of billing plans. When we compared plans, we found a number of retailers that sold the exact same devices with slightly different prices and plan details — that’s because what you’re paying for, essentially, is the 24/7 access to the call center. The monitoring centers might be contracted by retailers, but other providers (such as Phillips) manufacture their own devices and run their own call centers.

Range of P.E.R.S. plans

Plans can range from $20 per month (the lowest cost we encountered) for a basic package that uses a landline to $678.40 a year (the highest cost we encountered) for a package that uses cellular and includes three different devices for use in and outside the home. Some cell phones are also specifically created for older adults, like the Jitterbug, and these connect the user with the company’s 24/7 monitoring service. There may also be a one-time activation fee and possibly an equipment fee that can range from $50 to $100.

There’s also a choice of wearable devices. These can be pendants or wristbands. Some require the wearer to be in range of the in-home base, meaning they really only function within the home. We found devices with ranges from 600 feet to 1,400 feet from the in-home base.

Other devices are equipped with a global positioning system (G.P.S.) so they can be used anywhere. These are known as “mobile” devices and they’re becoming increasingly available. A monitored device with G.P.S. can be helpful in cases when the user is unable to tell the responder exactly where they are; the center can use the G.P.S. to locate you and send help. Devices are typically battery-powered; in-home bases can have battery lives in terms of years while mobile devices need to be charged anywhere from every 24 hours to every few days.

An important feature to consider is automatic fall detection. Many wearable devices now offer this as an option; it uses a sensor to register a falling motion and then no motion shortly after. The device will then call 911 or the monitoring center, depending on your plan. There is typically a small additional monthly fee for this capability; we commonly saw $10 per month.

It’s worth noting that fall detection isn’t a 100% guarantee: sometimes the sensors are too sensitive, triggering false alarms, or not sensitive enough, triggering… no alarms. But the technology is improving, especially with the Apple Watch marketing fall detection as a health feature for all ages.

What about smartwatches?

There’s a new ad for the Apple Watch highlighting its emergency and medical alert capabilities. Gizmodo called it “terrifying,” as it features a person in a car accident, one who broke a leg out on a farm and another who was swept out to sea while paddle boarding — ideally situations you and your older loved ones never find themselves in — all using their Apple Watches to call 911.

Smartwatches offer a wider array of health features than a traditional medical alert, like fall detection, step-counting, audio-monitoring and even notifications of irregular heartbeats (a feature of the Apple Watch that isn’t approved by the Food and Drug Administration).

Dr. Richard Caro, a researcher and investor in technology for aging in place, says the emergence of smartwatches has helped push medical alert companies to develop and sell their own watches, some of which have additional features or apps that make them more useful than single-purpose medical alert devices. And there’s an advantage to them that often goes unnoticed.

“A lot of people are given them or buy them, but then don’t wear them,” he said, about traditional medical alert pendants or wristbands. “So one of the attractive aspects of the smartwatch concept is that it’s cosmetically attractive, which maybe means you’re more likely to wear it. And then if it has other smartwatch features that you like, like telling the time, you’re more likely to have it on for other reasons. It’s not just a safety product.”

Caro co-founded Tech-Enhanced Life in 2013, a research outlet that facilitates groups of older adults to test out and review different types of technology for aging in place. He spoke with ClearHealthCosts over Zoom. TEL has a fairly comprehensive guide to medical alert devices, with in-depth reviews of around 50 devices and a selection tool that narrows down choices based on many of the features we’ve just gone through. If you’re ready for a deep dive on these devices and systems, it’s worth a click.

There can be disadvantages to smartwatches too: screens are small, they need to be charged daily and they’re more complex to learn and use. An Apple Watch doesn’t require a monthly payment plan like a traditional device, but that means there’s no 24/7 monitoring either, just a direct call to 911. A wearable device with an accompanying app may be particularly useful for users with cognitive decline or dementia, as the app can enable family members to monitor and ensure their loved one is in a safe location.

The bottom line?

Price will tend to increase with the complexity of the technology or plans, and the number of special features.

Lower: typically packages that include in-home bases that hook up to landline or cellular networks and wall buttons — these only work inside your home. We saw some plans that included a wearable device that responded with the in-home base for a higher monthly charge. Plans for monitoring can be billed monthly, annually or somewhere in between; we saw prices totaling between $200-400 per year or $20-$40 per month.

Middle: the next price point builds off of basic packages, with packages that include in-home bases and buttons plus wearable devices with GPS for consumers who want to be covered when they leave the home too. You will see the option to include fall detection here, commonly for $10 per month. We saw plans priced between $300-$600 per year or around $30-$50 per month.

  • Single mobile devices are also sold and tend to be pricier. A single mobile device from Phillips, say, would cost you $600 per year.
  • Lively has a few choices for mobile devices but the prices vary based on the monitoring plan, say if you simply want the urgent response or you wish to add a telehealth service they offer for a higher charge.

Higher: the price points where you’ll find most “smart” devices and packages with multiple devices. You’ll typically pay a fee for the device itself, or set up or activation (can be over $100). The monthly monitoring plans are also typically higher-priced; we saw plans from $30-$70 per month. Depending on how many features the watch includes, they can be useful for more than just emergencies and may be easier to integrate into daily life.

  • Some retailers sell packages of smartwatches with in-home bases, like Bay Alarm.
  • The Lively smartwatch requires their smartphone and app, taking the price even higher.
  • There may be monthly fees for access to apps that can allow the user or family to monitor the wearer’s health; we saw prices around $10 per month.

A few words of caution

This market has been ripe for scams and shady dealings. In December 2021, the Federal Trade Commission paid out over $1.8 million to consumers who had been defrauded by LifeWatch, a New York based company the F.T.C. alleges tricked people into “paying for supposedly free in-home medical alert devices.” The company “bombarded” older people with automated voice calls saying they’d been signed up for a “free” medical alert device, gathered thousands of consumers’ personal information, and got them on the hook for monthly monitoring fees they found hard to stop.

A 2014 report from the Senate Committee on Aging revealed that a majority of calls made to a fraud report hotline were about medical alert scams like this one. We also came across a number of consumer reviews on the Better Business Bureau site that allege difficulty canceling long-term contracts with companies like LifeAlert — so be sure to read the fine print if you are signing a contract.

Another consideration: cellular networks are planning to phase out their 3G services by the end of 2022. Some medical alert companies that sell devices that rely on 3G networks are struggling to transition their existing customers. Look for devices that operate on 4G or 5G if you plan to purchase before the end of 2022.

And if you’re Googling to find reviews of these devices, you’re going to come across a lot of faux-helpful articles that are thinly-veiled marketing material. These are loaded with search-engine optimization (S.E.O.) keywords to make the articles come up fast on a Google search with links for affiliate marketing revenue, by which a web site can collect money for referring people to a purchase.

Be careful of overly positive or vague reviews, and look for sources who have actually tested the devices, like Tech-Enhanced Life. We found helpful resources from reputable sources like Wirecutter, Forbes, AARP and the Washington Post as well.

What you can do

Knowing what your options are is just the start. Dr. Leslie Kernisan is a San Francisco-based geriatrician who runs the Better Health While Aging blog to help older adults age in place and advise caregivers. She says it’s vital to have a discussion with your older loved one about using a medical alert system and how it could actually fit into their lifestyle.

“Before you try to convince somebody to do anything, you start off by trying to understand their perspective and how they see it, and what’s most important to them,” she said in a Zoom interview with ClearHealthCosts.

In her work with older adults, she said, she’s seen that many can be resistant to adopting an alert device — it may feel like a constant reminder of how aging is changing their lives. They may feel defensive as you reveal your worries about their safety, or be reluctant to spend extra money on a new tool.

“You’re going to gently try to fill in those gaps and frame your suggestion as a way to help them get what’s important to them,” Kernisan said. She also emphasized considering your loved one’s cognitive abilities: is it reasonable to get them a device they have to remember to put on every day and charge every night? It can be especially difficult to help your loved one when cognitive decline is impacting their decision-making and you disagree about what’s in their best interest. Her book, When Your Aging Parent Needs Help, is a guide to navigating sensitive situations like this while respecting older adults’ dignity and autonomy.

You may also find it informative to look at the sources that have tested the devices (see list above). You might also want to talk with other consumers in a similar situation. Kernisan recommends starting with destinations on Reddit like r/CaregiverSupport or r/AgingParents or discussion forums on AgingCare.com.

That’s exactly what Tyrell did: he recently posted on Reddit that he was looking for a button he could set up to call him directly when his grandmother was in pain or needed help. In the meantime, he’s decided to put together a customized system for his grandmother based on her lifestyle and needs.

“I’m not just trying to solve it if there’s an emergency,” he said. “I’m trying to solve the issue of, is it going to be available? Is she going to be able to use it? So it’s not just some single facet problem.”

He recently bought an Apple HomePod mini, a voice-activated smartspeaker that his grandmother won’t need to remember to wear or charge inside the apartment. He’s planning on buying a couple more to set up in every room as a makeshift intercom system. It’s a solution that took some time to come to fruition. He bought his grandmother a smartphone and tablet around five years ago and has been showing her how to use them more regularly as part of her daily life: getting the weather forecast, telling the time or asking Siri questions.

“With the iPad, that was a five-year process,” Tyrell said. “It’s still ongoing. But that’s how it goes with this stuff, a lot of training and a lot of getting used to it. So that’s why I went with this.

“It’s not just for emergencies; she can use it every day and start getting in the habit of using it every day, and it’s not intrusive to her.”

He’s still considering the options for when she leaves the house, like an Apple Watch, but for now, she’ll continue to rely on her “buddy” system with friends and neighbors for short errands — and Tyrell will remind her to take her phone along.


This story was produced through the New York & Michigan Solutions Journalism Collaborative, a partnership of news organizations and universities dedicated to rigorous and compelling reporting about successful responses to social problems. The group is supported by the Solutions Journalism Network. The collaborative’s first series, Invisible Army: Caregivers on the Front Lines, focuses on potential solutions to challenges facing caregivers of older adults.


Mary Steffenhagen

Mary Steffenhagen is a Brooklyn-based journalist and audio producer. Trained in investigative reporting, her journalistic ethic is shaped by a knowledge of historic injustices...