Questions/Answers

To ensure that elderly persons can live safely and independently, the Government Assisted Living Eco-system (GALE) was created. GALE is the first fully deployed service by the Singapore Government that uses IoT devices. It consists of interoperable passive and active monitoring hardware products, a CMS to receive these alerts and a crowdsourcing mobile application for users. GALE comprises a hardware IoT button (the Personal Alert Button or PAB); a case management system and is supported by 24-hr telecare operators and staff from Senior Activity Centres, (SACs) which are elderly social care support centres located in the vicinity of the user’s residence. PABs are installed in the senior’s homes at places where the probability of falls is higher. To call for help, the elderly person presses the PAB which will alert the SAC or a telecare-operator. Within minutes, assistance is rendered. For emergency cases, an ambulance will arrive in less than 10 minutes. With GALE, more seniors can live safely and independently in their own homes by providing fast responses to emergency situations in their homes. The elderly will be able to receive 24/7 help. It proved to be very useful during the two-month COVID-19 lockdown in 2020 as it was the frontline in providing emergency assistance to the elderly who were without their usual support network. The Content Management System (CMS) also enabled volunteers to deliver necessities.

To date, GALE has assisted 100,000 elderly and 35,000 rental tenants. This response model reduces potentially fatal incidents with active and passive monitoring solutions supported by close partnerships with SACs, operators, and government agencies. PABs are easily installed as the devices don’t require electrical wiring. Profiles of elderly, call records, and medical history are easily retrieved using a CMS that cross-shares information, letting SACs and tele-care operators render help sustainably and reliably. Health agencies can plan/allocate resources, housing agencies can provide elderly-friendly services for public housing, and timely emergency services can be provided. Agencies can further aid 35,000 vulnerable residents.

Goal 1: No Poverty (1.3 and 1.5) and Goal 10: Reduced Inequalities (10.2 and 10.4) To date, GALE assisted the well-being of 100,000 elderly and 35,000 rental tenants, supported 10,157 seniors through assisted-living monitoring, handled 3,190 cases and 397 urgent/life-threatening cases. Cases are received and responded to by the CMS 100% of the time. Before GALE, there was a lack of a cost effective, easy-deployable Personal Emergency Response System (PERS). Elderly had no clear way to call for assistance during an emergency. They tend to stay in areas where neighbours are also elderly and are unlikely to be reliable respondents. There is potential to onboard all the social agencies onto this centralised platform to provide better social services and care to more people. Health agencies can plan and allocate resources better, housing agencies can provide elderly-friendly services for public housing, and the emergency services can be rendered more efficiently. With GALE’s CMS, profiles of the elderly, previous call records and medical history can be displayed upon PAB’s activation so that help is rendered in a more sustainable and reliable manner. During the COVID-19 pandemic lockdown period in 2020, GALE was the frontline in providing emergency assistance to the elderly who were without their usual support network, and enabled volunteers to deliver necessities. This response system reduces the number of potentially fatal incidents using both active and passive monitoring solutions that is supported by the close partnership with SACs, operators and government agencies, forming a strong private public partnership in the process.

GALE as a part of the Singapore Government Tech Stack does not stop just here. The case management platform of the GALE system has continued to be reused in serving many other use cases which ranges from vaccination engagement of the seniors, grocery vouchers appeal, operation of Singapore government integrated service centres and many others. The Tech Stack approach allows us to react to new demand and changes in a more agile manner through faster, cheaper and security and best-practice by design service delivery. In several COVID response tracks, the team reuses the Stack and pushes out new tracks of government digital services within 2 weeks’ time – which is impossible if we do not have GALE as the base stack. 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.

NA

1)Elderly who are staying alone and those who can't afford private PERS. This initiative has supported 5,636 elderly. 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 Operators who have full views on the elderly's particulars, call for help status, and incident logs and are able to relate and follow-up with elderly without repeating the situation to different staff 3)Ministry of Health, which provides economies of scale where telecare operators are able to support elderly across Singapore while leveraging on SAC during the day. 4)Housing Development Board, which provides ease of addition and removal of the buttons due to people movement and are poised to provide an elder-friendly service for public housing that reduce cases of elderly passing away at home unknown. 5)Singapore Civil Defence Force, whose telecare operators can call for an ambulance when elderly is not contactable. 6)Silver Generation Office, which are in contact with 100,000 elderly to ensure their well-being and can leverage on volunteers to support elderly in buying groceries, food and medical appointments. 7)Ministry of Social and Family Development, that can contact 35,000 rental tenants to ensure their well-being.

KPIs were established to track the progress of this product. The desired outcomes are technical reliability and usability; corresponding KPIs were matched to these outcomes with the results being displayed below. • Technical reliability: Cases are received and responded to by the case management system 100% of the time. • 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 Results: • Supported Tele-Ops – 100000 elderly and 35000 rental flat tenants. • Seniors supported through assisted-living monitoring: 10157 • Cases Handled: 3190 • Urgent/Life-threatening Cases Handled: 397

GALE was implemented in phases using agile product development framework 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 further reduce to the response time. - Obtained system feedback from elderly, SAC and telecare operators. c) Re-design GALE version2.0 i) Version 2 of PAB: Enhanced with 10 seconds of recording upon battery press, increase battery life, button has feedback trigger, allowing 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) Referral of cases to other Government agencies to support the vulnerable iii) Appeal module were created to support those in need of government financial vouchers to purchase groceries.

PAB uses Low Power Wide Area Network as a substitute to costly cellular services, driving down GALE’s cost by sending voice over LPWAN (VoLPWAN) instead of using a costly VoLTE solution (mobile phone/cellular). With cost reduced by integrating the services into the cloud, we developed a web service to retrieve alerts and a crowdsourcing mobile application to respond to these alerts. An agile development framework and Design Thinking guided us towards suitable and sustainable solutions. 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.

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. The above and the care model were outcome of the design thinking approach, to suite the outcome to support the vulnerable group after a few iterations.

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.

No. But the team is in the progress of working to scale from 53 blocks of government housing to island-wide deployment.

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.

Agile development framework and Design Thinking led to suitable and sustainable solutions. While there are commercial PERS solutions available, these are not economical for those living independently without a support network. PAB uses Low-Power-Wide-Area-Network (LPWAN) as a substitute to costly cellular services, driving down GALE’s cost. The team innovated a new device to send voice-over-LPWAN (VoLPWAN) instead of costly VoLTE solutions (mobile phone/cellular). Cost were lowered through integrating the services into the cloud, a web service to retrieve alerts, and a crowdsourcing mobile application to respond to these alerts.

Yes

KPIs are established in the table below to track the progress of this product. Desired outcomes included: 1) Technical reliability - KPI: Cases are received and responded to by the case management system 100% of the time. 2) Usability - KPI: 85% satisfaction rate of care operators using the care management system achieved through post-trial user interviews and surveys. - KPI: 85% satisfaction rate of the trial users using the personal alert buttons achieved through post-trial user interviews and surveys.

KPIs are established in the table below to track the progress of this product. Desired outcomes included: 1) Technical reliability - KPI: Cases are received and responded to by the case management system 100% of the time. 2) Usability - KPI: 85% satisfaction rate of care operators using the care management system achieved through post-trial user interviews and surveys. - KPI: 85% satisfaction rate of the trial users using the personal alert buttons achieved through post-trial user interviews and surveys.

KPIs are established in the table below to track the progress of this product. Desired outcomes included: 1) Technical reliability - KPI: Cases are received and responded to by the case management system 100% of the time. 2) Usability - KPI: 85% satisfaction rate of care operators using the care management system achieved through post-trial user interviews and surveys. - KPI: 85% satisfaction rate of the trial users using the personal alert buttons achieved through post-trial user interviews and surveys.

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.

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 kin 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.