Questions/Answers

Singapore estimated that 83,000 elderly persons will be living alone by 2030 as compared to the 47,000 elderly aged 65 and above in 2016. With a belief that every elderly has the right to age safely while living alone, the GALE eco-system was created consisting of i) hardware IoT button, the Personal Alert Button (PAB) ii) Case Management System (CMS) and iii) 24 x 7 telecare operators and senior activity centre (SAC) staff. These buttons are installed within the elderly’s house at places where the probability of falls are higher. In times of emergency, the elderly could call for help by pressing on the button which will alert the Senior Activity Centre (or SAC - an elderly social care support located in the vicinity of the elderly residence) or a telecare-operator. Within minutes, the respective personnel will contact the elderly to render assistance. For emergency cases, an ambulance will arrive in less than 10 minutes regardless of the place of residence. As of 29th October 2020, the system has been deployed to 23 rental blocks in 11 months. Of which, there were 830 number of genuine triggers & 133 lives were saved. This was especially crucial during COVID-19 movement restriction, in which the SACs were shut down and elderly are advised to stay at home. Such measures posed challenges for the elderly especially those who live alone as they struggle to buy basic necessities. GALE CMS was further enhanced to support the outreach of both the vulnerable and underprivileged groups and to offer assistance to them. The assistance ranges from food, grocery, accompaniment of elderly to medical facilities to mental health, employment, finances and other needs. In less than 5 months, the new tele-operations had supported the outreach to approximately 100,000 elderly and 35,000 rental tenants.

Goal 3: Upon triggering the call for help, the telecare operator will detect the location of the elderly and will contact him/her within minutes. If the elderly do not respond, emergency services will be activated. Till date, GALE has facilitated in checking on the well-being of 100,000 elderly and 35,000 rental tenants. Goal 17: This response model reduces the fatality of the elderly through the use of both active and passive monitoring solutions while supported by close partnership with SACs, operators and government agencies. This has proven to be very useful during this COVID-19 pandemic.

GALE supports SGDs 3.4, 3.8, and 17.17. GALE has potential to expand in providing 24 x 7 emergency assistance to all the socially isolated elderly. Continuous enhancements to the hardware will be made such as leveraging on LTE CAT-M and to implement a new model of buttons that could allow “2-way communication” i.e. SACs and telecare operators can communicate directly with the elderly even if the elderly does not own a phone. With the aim of extending GALE to all elderly in SIngapore, there is a possibility to reduce by one third premature mortality from non-communicable diseases through early intervention (e.g. early fall detection, heart attack and stroke) by 2030. Telecare operators who actively outreach to the elderly and underprivileged would help to check-in on elderly’s mental health and well-being. This would provide the elderly and the underprivileged access to quality essential health-care service. The GALE eco-system has allowed us to collaborate with the private telecare-operators forming a strong private public partnership. There is potential to onboard all the social agencies onto this centralised platform to provide better social services and care to more people.

With GALE, more elderly can live safely and age independently in their apartment instead of being admitted to hospital, nursing home or other healthcare facilities pre-maturely. This helps to free our medical manpower for people who need it most. Telecare operators often conduct active outreach to elderly to check on their well-being and offer assistance. This will reduce the possibility of social isolation and depression. With a common system to share information, SACs and tele-care operators can partner together to render help to these elderly in a more sustainable and reliable approach. Both operations would achieve sustainable social impact.

Before the implementation of GALE, there was a lack of a cost effective, easy deployable Personal Emergency Response System (PERS). These elderly are worried that if they require help during an emergency, nobody knows. Some elderly don’t fully close their main door at night with the fear that nobody can hear them. Most elderly also stay in the areas where most of their neighbours are also elderly and they are unlikely to be reliable respondents in times of need. Though there are SACs around Singapore, it is very expensive to have people to stand-by 24 x 7 at the centres to respond. With GALE, elderly will be able to receive 24 x 7 help with SAC being able to respond during office hours and to the telecare operator after office hours. With GALE’s CMS the details of the elderly will be displayed upon button press. GALE CMS will display the history of the elderly e.g. what were the previous calls for help, if they had recently been discharged from the hospital allowing both SAC and operators to respond effectively. The PAB can be easily installed in any apartment as the device do not require electrical wiring.

With GALE, all elderly will be able to receive 24 x 7 help with SAC being able to respond during office hours and to the telecare operator after office hours.

1) Elderly who are staying alone a) Rental Elderly does not have the financial capability to afford private PERS. This initiative has supported 5,636 elderly. b) Call for help buttons are located in places where they often spent the most time unlike the earlier system which is hard-wired to fix locations within the house. 2) SAC & Telecare Operator a) Has a full view on the elderly particulars, call for help status and incident log. b) Able to relate and follow-up with elderly without repeating the situation to different staff 3) Ministry of Health a) Economies of scale where telecare operators are able to support elderly across Singapore while leveraging on SAC during the day. 4) Housing Development Board a) Ease of addition and removal of the buttons due to people movement. b) Provide an elder-friendly service for public housing. c) Reduce the cases where elderly pass away at home without anyone knowing. 5) Singapore Civil Defence Force a) Telecare operators are able to call for an ambulance when elderly is not contactable. 6) Silver Generation Office a) Contact 100,000 elderly to ensure their well-being and leverage on volunteers to support elderly in buying groceries, food and medical appointments. 7) Ministry of Social and Family Development a) Contact 35,000 rental tenants to ensure their well-being.

GALE was implemented in phases using agile product development framework allowing the team to determine the effectiveness of the response model, hardware and acceptance from elderly. a) Onboarding - Off-the-shelf IOT buttons were installed in 20 households; in bathroom, living room and kitchen b) Roll-out to 20 households - Simple system to allow SAC and telecare operators to view and update the case details upon each button press. Able to track where to further reduce to the response time. - Obtained system feedback from elderly, SAC and telecare operators. c) Re-design GALE version 2.0 i) Version 2 of PAB : Enhanced with 10 seconds of recording upon battery press, increase battery life, button will have feedback trigger upon press, allow elderly to cancel the call for help. ii) Device management system to track the battery life, detect the heartbeat status of each PAB. iii) Version 2 of CMS: To have an end-to-end workflow from initial button press to case closure for 200 elderly households. Telecare operators are able to activate ad-hoc volunteers to check on the elderly. iv) Pilot of responder mobile app : Volunteers can be notified to check on the elderly within 2km of their location. d) Nation-wide roll-out (53 rental flats) i) Elderly is attended to in the shortest possible time. i.e. if SAC does not respond, this request will be sent to the telecare operator in 5mins. ii) Performance dashboards were developed to track SAC versus others to nudge towards shorter response time. e) COVID-19 enhancements i) Outreach, assignment modules created for volunteers to run errands for elderly. ii) Allow referral of cases to other Government agencies to support the vulnerable elderly. iii) Appeal module were created to support vulnerable elderly who are in need of government financial vouchers to purchase groceries.

1) Simple Button - Deeper ingress to prevent accidental presses. - Only 2 functionality, press to call for help and a side cancel button. 2) Low-cost and reliable response model - Previously, elderly did not use the pull-cord system as the alarm would alert the whole block. - GALE will ‘silently’ alert both the SACs/telecare operator when the button is pressed. 3) Lower response time - Dashboard to display the total response time taken to close each case for all SACs and telecare operators. - For vulnerable elderly without a phone, their case will immediately trigger the call for an ambulance. This ensures every case will be duly responded to.

The technology layer consists of interoperable passive and active monitoring hardware products, a CMS to receive these alerts and a crowdsourcing mobile application to support these elderly. GALE is the first fully deployed Singapore Government service incorporating the use of IoT devices. Private PERS solutions are targeting more well-off elderly but independent living is not only for the more affluent elderly. Everyone has the right to age independently and public service should offer this service. We can potentially work with the private industry to expand the suite of services so elderly don’t need to be prematurely admitted into nursing homes.

Most of these countries have implemented PERS that requires elderly to be equipped with a mobile phone using geolocation and to contact the elderly who requested help. We drew inspiration from private PERS solutions for elderly and recreated a model which would fit Singapore’s culture.

PAB uses Low Power Wide Area Network (LPWAN) as a substitute to costly cellular services, driving GALE’s cost down to a lower price. We have also innovated a brand-new device to send voice over LPWAN (VoLPWAN) instead of using a costly VoLTE solution (mobile phone/cellular). Being able to scale the cost down while integrating the services into the cloud has allowed us to develop a web service to retrieve alerts and a crowdsourcing mobile application to respond to these alerts. Using agile development framework with design thinking, the research has guided us to envision suitable solutions.

NA.

The emergency response model and outreach model could be replicated to other countries provided that they have the policy in place to take care of the elderly and underprivileged. In order for such models to be successful, they would also need to have a 24 x 7 teleoperator to handle all the operations and SACs who can take care of the residents within each vicinity. National policies to nudge elderly towards independent and active living so there will be lesser elderly being pre-maturely admitted to hospitals and nursing homes. The hardware and software would then be the enabler to make this solution a success. As most of the elderly are staying in high-rise apartments, only a limited number of gateway is needed and hence we can significantly reduce the cost.

Partners (Government and non-government entities), volunteers, policy, money for development and maintenance of the system and a dedicated cross functional public service team with heart to do good for the people is what makes this initiative successful.

GALE’s products consist of PAB and CMS and they are planned to scale up as a SaaS model. GALE could potentially be offered to all the elderly in Singapore to ensure that all elderly are covered with a basic response model to ensure timely emergency assistance. GALE CMS could be expanded to cover more use cases relating to serving the social sector and the elderly sector.

Yes

A comprehensive evaluation report of the project's progress was drawn up and evaluated by the business owner (MOH (Ageing Population Office) and the system/asset owner (GovTech).

Indicators and KPIs were established to track the progress of this product. Desired Outcomes: A) Technical reliability KPIs established for technical reliability: - Cases are received and responded to by the case management system 100% of the time B) Usability KPIs established for usability: - 85% satisfaction rate of care operators using the care management system achieved through post-trial user interviews and surveys. - 85% satisfaction rate of the trial users using the personal alert buttons achieved through post-trial user interviews and surveys.

There is a growing number of elderly (65 years and above) living alone and Government estimated that the number of senior living alone would go up to 83,000 by 2030. Current emergency response systems are either too outdated (HDB’s Pull Cord System) or too expensive (Certis Cisco/Red Cross PERS), and with the Pull cord system requiring a technology refresh, MOH & HDB were looking for technology solutions to replace the old system, using a wireless technology. All outcomes have been met and the next step for the team's action is for Wireless AASin the next phase for other identified target audience.

A multi-agency task force was set up to evaluate the ageing population in Singapore. Key stakeholders are part of the team to ideate the Minimum Viable Product. These business users are very familiar with the domain and through this co-creation process we not only have innovative solutions but also buy-in from these users. With a start small, think big and be bold mentality, a trial was conducted with 20 households, thereafter 200 households to iterate and improve this product. Multiple Government agencies also create new policies to ensure elderly-related technology and policy can work hand-in-hand together towards a nationwide deployment.

Elderly - co-creating with a group of elderly from 20 household before we scale up to 200 households. CareLine -Telecare operator, part of Changi General Hospital group. Agency for Integrated Care (AIC) - Agency managing elderly well-being. Ministry of Health (MOH) - Ministry managing healthcare. Housing and Development Board (HDB) - Agency managing public housing. Silver Generation Office (SGO) - Agency managing elderly above 60. Ministry of Social and Family Development (MSF), Family Service Centre (FSC), Social Service Office (SSO), People's Association (PA) - Ministry/agencies managing social welfare.

Inclusivity: Elderly and vulnerable groups have different needs e.g. fear of technology and resistance to perceive complex product. Hence, the team co-created this solution with a group of elderly and many rounds of field testing were conducted to ensure the usability and effectiveness of this product. Assurance: We have allowed for greater visibility for elderly to activate a 24 x 7 fast emergency response service to safeguard the elderly living alone in Singapore. As most PERS relied heavily on next of kins to be the main responder, we ensured that every case is handled by a dedicated team of telecare operators to handle these cases. Scalability and Reusability: The service layer is the crux of the ecosystem, with the technical layer working as the enabler to support GALE. GALE was designed to be interoperable to ensure both private and public services would have easy integration into the ecosystem. Improvements: To improve the initiative, the team is further looking into integrating more non-invasive passive monitoring solutions and wearables into the ecosystem. The team has researched into including other methods of analysis like gait analysis, vital signs monitoring, fall detection and sleep quality.