Emergency Alarm

Hungary

1994

To allow at-risk older people (poor health and financial difficulties) to live independently and to help informal carers reconcile work and care.

The Emergency Alarm system was a pilot program launched in Hungary in 1992 by a large NGO, the Hungarian Maltese Charity Service (HMCS), with financing for one year provided by an international project. HMCS has financed it for a long time, but has struggled to obtain public funding. Over time, the model was expanded to backward regions of the country as well. The rationale was to allow older people at risk (i.e., with moderate to serious chronic physical or cognitive disorders and with financial difficulties) to live independently through the combination of technology and formal home care. Informal carers are supported as well.

In 1994 the Emergency Alarm Service was a device resembling a wristwatch used by the elderly to summon help in case of a crisis, especially in case of falls at home. The device sends signals to the 24-hour control centre of a care centre.

After continuous development of the model and its successful integration into different conditions the system was incorporated into the Hungarian social eldercare. Persons covered by the system receive some form of social care provided within the frame of home care as a mandatory local government service.

 Care Recipients
 Informal carers
 Paid assistants
 Formal carers

The main target users are older people with physical and/or cognitive capacity limitations.

 Independent Living
 Information and learning for carers
 Personal Support and Social Integration for carer
 Care coordination

Support for dependent older people; support informal carers’ quality of life, allowing them to reconcile care with work better and have more leisure time.

The system for working needs a fixed base at home and a device similar to a wrist watch. The first receives the signal from the device worn by the frail person and transmits the call to the emergency centre .

Both public and private

Public service funding: Government, Regional, Local Authorities, non-profit public entities

Public service funding: agreements with Local Governments financed by State.

Non-profit funding: charity, volunteers organisations, NGO

Not available

The Governament’s fundsin 2008 and in 2009 amounted to 3,448,276 EUR (1 billion HUF), in 2010 it was 3,214,286 (900.000.000 HUF), then somewhat less in the following years.The organisation has its own funds and provides a certain number of users with equipment who otherwise could not afford it.

 

The emergency alarm system was initially a pilot program launched in 1992 by a large NGO, the Hungarian Maltese Charity Service (HMCS), and was financed by an international project for one year. To maintain the system, the HMCS has financed it for a long time, struggling to obtain public funding. With development of the model, it became possible to set up the emergency alarm system in impoverished regions of the country as well.

The NGO has a contract with local governments (financed by the state budget) to provide the emergency alarm system, free of charge, to some older people and to others for a fee according to their pension and the regulations of the local government. However, the demand is much greater than the local government can satisfy. In certain cases, the HMCS provides devices free of charge.

In 2011, the Methodology Centre of the Hungarian Maltese Charity Service ensured the suitable operation of the system and the quality of the home care associated with it, even for services provided by local governments. A result has been uniform eldercare based on ICT and human resources, in which the burden on formal carers has been eased.

For a long time the public sector had no interest in ICT solutions for eldercare and therefore did not finance it. This situation changed in 2000 when more and more local governments provided the service and different companies began to offer increasingly modern alarm systems. However, the HMCS continues to play an important role in supporting frail older people and their family carers by providing the emergency system free of charge as many local governments do not have an emergency alarm system at all, or only have a limited number of devices.

Under the provisions of the Social Welfare Act, the ICT-based assistance can be part of essential services, but is not mandatory. Diffusion of the service depends on the financial conditions of the local authorities, on the prices offered by the market and the current financial situation of the older people. An increase in the number of market actors and the resulting competition could lower prices and speed up the dissemination.

Currently there are several forms of financing the service, depending on who pays for it. The contracting partner can supplement this sum from its own sources. In the case of a church service provider the basic normative is supplemented by the 80% church supplementary normative. In regions with a low population density and in underdeveloped areas, an incentive sum of 25% is added to the basic normative disbursement. Within this financing structure the fees can be kept at a low level. In the current economic climate in which the social services are underfinanced, there is little chance of expansion.

€ More than 500,000

€ More than 500,000

Budget for setting up the initiative: 3,448,276 € (2008-2009) (Szeman, 2013)

Budget for implementing the initiative: 3,214,286 € (2010) (Szeman , 2013)

 

 

 Authorities
 Private Care Sector
 Health and Social Care Systems
 Third Sector
 Private Companies

Not available

The Third Sector partially provides the service.

 Informal Carers
 Health Professionals
 Social Care Professionals
 Privately-Hired Care Assistants (inc. Migrant Care Workers)
 Volunteers

The professional carers, or the village caretakers, in the case of isolated farms and scattered settlements, assess the existing demands in basic care that can be met under regulations. In 2011, around 2,500 professional carers, with secondary-level health qualifications and working full time, ran the initiative.

The number of volunteers working in the organisation’s own care centre is increasing, in contrast to the national trend. Volunteers receive 20 hours of training and supervision is regularly carried out in monthly meetings. There are more than 1,000 volunteers who receive a token fee mainly on night duty. Almost two-thirds of them are retired nurses.

There is also continuous communication with the informal carers. The volunteers help in eldercare and check that care recipients use the device is being worn.

10,001 - 50,000

Because of a change in the funding regulations (service no longer provided free of charge or for a very low fee), many older people cancelled the service although they still needed it. The number of people covered by the system fell from the earlier 30,000 to around 20,000. This figure then began to rise slightly with the appearance of new older recipients of home care. In 2012 approximately 1.4% of the population over 65 years old (more than 20,000 people) received the Emergency Alarm system.

The Hungarian Maltese Charity Service presents the service on its website (in Hungarian only). Additional promotional channels should be implemented, because many families of impaired older people still do not know of the existence of this service.

The Methodological Centre of the Hungarian Maltese Charity Service carried out several impact assessment research projects as well as representative surveys in 2006 and 2010 among elderly and informal carers. The results of this representative survey showed the positive impact of the Emergency Alarm System on the families. In 45% of cases at least one family member mentioned that it eased their burdens: the decrease or disappearance of stress, or/and somatic health problems, reconciliation of care and work and/or more leisure time. The known major impact is the full integration in the eldercare system with a positive impact on the quality of life of older people, their family carers, as well as the cost saving for the health and social systems (Széman, 2013).

This service benefits:

- Companies and the labour market, because it helps the informal carer to reconcile work and caring tasks and may help to avoid the added costs for substituting/replacing the worker. The need to leave the workplace in emergencies and to work overtime to make up for time spent away in emergencies, can cause informal carers stress and health problems (high blood pressure, gastrointestinal problems, medicine use, etc.). After the installation many of the informal carers gained psychological support, some of their health problems disappeared, many of them had more leisure time, and work and usually care could be more easily reconciled. (Széman, 2013)

This service benefits public authorities, the National Health Insurance Fund and social care services by helping to save the cost of home caring and hospitalisation. In addition, since the Methodology Centre of the Hungarian Maltese Charity Service ensures the right operation of the system as well as the quality of the home care provided by local governments, the service helps to optimise financial and human resources. As a result uniform eldercare based on ICT and human resources has been implemente (Széman, 2013).

Strengths:

1. There is no need for training, as the use of the alarm system is very easy.
2. The system is easily transferable.
3. The service was free of charge for some citizens at the beginning.
4. The service is integrated into the care system and regulated by law.

Weaknesses:

1. The initiative Emergency Alarm does not have a separate website. On the website of the Hungarian Maltese Charity Service (HMCS) (www.maltai.hu) the English page does not provide specific information on the project. After the regulation's change happened in 2009local authorities must submit applications to fund operation of the service. This often results in the termination of the free service. Although the fee did not exceed 2% of a family’s income this caused 28% of care recipients to request discontinuation of the service. Obviously, these older people are not users of market services.
2. The resistance of decision makers to the use ICT in eldercare and, as a consequence, long-standing financing problems.
3. Lack of information is also a problem. At present many family carers do not even know of the existence of the service.
4. Not all areas are covered by the service and capacity is limited. Thus not all those in need have access to the service.

Threats:

1. The organisation offered the ICT-based service in the public sphere, the largest segment using the service. This is supplemented by the organisation’s own related service. Compared to these, the purely market segment is very small.
2. Although the spread is not linked to specialised ICT knowledge, only a simple explanation, which can be provided by anyone, could be enough, the lack of awareness and the prevalence of self-deprecation among seniors could lead them at renouncing the service.
3. The emergency alarm has been incorporated into the home care services of local governments for older people and used to be financed by the state budget based on a per capita rate until 2009 . At the same time the charity organisation has its own budget to provide the service. Currently, this could be a problem with the decreasing financial resources of the public sector and the ability of the charity organisation to satisfy the needs of the growing older population.

Challenges:

1. Setting an even lower payment fee for older people.
2. Raise the awareness of the benefits of this service and alleviate the aversion that some potential elderly users might have to ICT devices.

The Maltese Charity Service continuously monitored and developed the alarm system to adapt it to different situations, especially in the most impoverished regions of the country (e.g. without electricity). Nevertheless, the service is not available for citizens in all parts of Hungary so far.

Expanding the scale of the service would present no difficulty and all elements of the service are replicable. Objective conditions for transferability to other European countries is the fact that the system is technically simple and can be adapted to the regulatory structure of any given country, enabling it to be integrated into the eldercare system. In the nineties the service received interested by East European Countries and in the mid-nineties it was implemented in Saint Petersburg and this is an example of how it was considered innovative also out of Hungary. Nevertheless, future developments depend on the policy on the elderly and on the availability of public funding.

References:

Hungarian Maltese Charity Service (2008). Activity report. Budapest: Hungarian Maltese Charity Service, http://www.maltai.hu/data/nodes/411/file/activity_report_2008.pdf (last access: 15 October 2011).

Hungarian Maltese Charity Service (2009). Annual report. Budapest: Hungarian Maltese Charity Service, http://www.maltai.hu/data/nodes/411/file/annual_report_2009.pdf (last access: 15 October 2011).

Szeman Z. (2013), Skype in Elder Care, case study in Santini S., Barbabella F., Lamura G., Deliverable 2.1- AIDA Project (Advancing Integration fo a Dignified Ageing)- Album of good practices, available at http://www.projectaida.eu/?page_id=11

Resources

http://www.maltai.eu/

Contacts:

Lajos Győri

Address Magyar Máltai Szeretetszolgálat,

1011 Budapest, Bem rakpart 28.

Telephone: 0036 202 3386 or 0036 225 8280

E-mail: gyori.lajos@maltai.hu