When you press a medical alert button, the device calls a monitoring centre that is staffed 24 hours a day, and a trained operator answers. You talk to each other through the device itself. The operator then follows the plan on your file, which can mean calling a family member, local emergency services such as the ambulance, or both.
That plan is the part most people never see until the day they need it. Knowing it ahead of time takes the mystery out of the button, for the person wearing it and for the family who suggested it.
Below, each step in order: the call, what you hear and say, and who gets called. Then how your location is shared, what happens after a fall alert or a press by mistake, and what your family sees.
What is a personal emergency response system?
A personal emergency response system, or PERS, is a wearable help button that connects you to people who can get you help. The Public Health Agency of Canada's Safe Living Guide describes these systems as "communication devices that will get help for you in case of an emergency," worn as a wristwatch or a pendant with a call button. Most people simply call them medical alert systems.
There are two broad kinds. A monitored system sends your call to a staffed response centre. An unmonitored system, sometimes called self-dial, skips the centre and calls 911 or a short list of numbers you chose, according to the U.S. National Council on Aging (NCOA). The steps in this post are for monitored systems, because that is where a trained person answers.
How the call travels depends on the system. Humber River Health's Seniors Care Program explains the difference. Basic systems connect your button to a base unit on your home phone line, which works within your home. Cellular systems can also be used outside the home and in the community. If you are deciding between those two, our guide to medical alert systems that work without a landline covers the trade-offs.
What happens when you press the button, step by step
Pressing the button starts a two-way call to the monitoring centre. An operator answers, talks with you through the device, checks the information on your file, and works out what help you need. Then, if help is needed, they contact the right people. Here is the order of events for a typical monitored system.
| Step | What happens | What you do |
|---|---|---|
| 1. You press | The device starts a call for help. With automatic fall detection, a possible fall can start it too. | Press the button the way your user guide shows. You do not need to reach a phone. |
| 2. The call connects | The call goes to the monitoring centre, over a cellular network or, on basic in-home systems, your home phone line. | Wait for a voice. |
| 3. Someone answers | A trained operator speaks to you through the device. | Talk in your normal voice. Say what happened and where you are. |
| 4. Your file opens | The operator works from your profile: your address, your emergency contacts, the order to call them, and any instructions you set up. | Nothing. This is why keeping that file current matters. |
| 5. A decision | The operator weighs what you say and what is happening. | Be plain: "I fell and I need help getting up," or "I'm okay." |
| 6. Contacts may be called | The operator may call your emergency contacts, local emergency services, or both. | Answer any questions the operator asks. |
| Pressed by mistake? | The call still goes through. | Stay on the line and say it was an accident and you are okay. |
No step comes with a promised time. How quickly a call connects depends partly on the cellular coverage where you are.
The button only starts the call. The plan on your file shapes who gets called.
What will you hear, and what should you say?
You will hear a live person speaking through the device, asking if you are okay and what happened. Answer plainly: where you are, whether you are hurt, and whether you can get up. If you are fine, say so. "I'm okay, it was an accident" is a perfectly good answer.
Depending on the device, you may first hear a short spoken prompt from the device itself before the operator comes on. A few examples of useful things to say:
- "I fell in the bathroom. My hip hurts and I can't get up."
- "I'm on the kitchen floor and I feel dizzy."
- "I pressed it by mistake. I'm fine."
If English is not your first language, ask about it when you sign up. With Holo Alert, for example, subscribers can set a preferred language for alert calls. French calls are normally answered by a French-speaking care team member, and many other languages are supported through professional interpretation, though the first voice you hear may be in English.
A test call is a good way to get used to the button before you ever need it. Holo Alert suggests a brief test about once a month. Press the button, and when a care team member answers, say, "This is a test. I am okay."
Who gets called, and in what order?
There is no single script. The operator considers what you say, what is happening, and the instructions on your file. Then they may contact your emergency contacts, local emergency services such as the ambulance, or both. Contacts are normally reached by phone, following the order on your file.
That flexibility is the point. NCOA describes it this way: in some cases the right help is a wellness check from a neighbour, and in others it is emergency medical care. A trained person on the line can tell the difference in a way a pre-recorded message cannot.
At Holo Alert, each monitoring profile holds one to five emergency contacts, with one marked as the primary contact. Calls are received at Canadian monitoring stations in Dartmouth, Montreal, Edmonton and Moncton, and you do not need to live near one. If emergency services are called, they are the ones local to you.
Three things worth settling as a family before anyone presses anything:
- Who is first on the list. Usually the person who lives closest, not the one who worries most.
- How a responder gets in. Humber River Health describes a lock box as a secured box that holds house keys, so you can give access to your home in an emergency. Ask your provider whether it can go on your file.
- Who keeps the file current. A changed phone number or a contact who moved away should be updated with the provider.
One cost surprises people. Ambulance charges are set by your province, municipality or service provider, and they are separate from any monitoring plan.
How does the monitoring centre know where you are?
Your file holds your home address, and mobile systems can add location services that help the operator find you when you are out. Treat location as a helpful clue rather than a pinpoint. Walls, weak signals and weather can all affect it, so saying where you are out loud still helps.
"I'm in the backyard, by the shed" gives the operator something no signal can. Every current Holo Alert device includes location services that can help the monitoring team determine where the wearer is. None of them need home Wi-Fi to place an alert call.
What happens when a fall is detected automatically?
Automatic fall detection starts the same call without a button press. When the device senses what looks like a fall, it begins a fall alert and gives you a chance to cancel it if you are fine. If you do not cancel, the device tries to connect to the monitoring centre, and the call carries on like the steps above.
The feature exists for the moments when reaching a button is hard. 47% of older adults who fell could not get up again without help, in a landmark community study (Tinetti and colleagues, JAMA, 1993).
On Holo Alert devices, fall detection is turned on by default and included at no extra cost. If you can press the button yourself, go ahead; there is no need to wait for the sensor. How the sensors decide that a fall has happened is its own topic, covered in our explainer on how automatic fall detection works.
What happens if you press it by accident?
Just tell the operator. The call still goes through, so stay on the line and tell the operator it was an accident and you are okay. Accidental presses are understood, and Holo Alert does not charge a false-alarm fee for them or for test calls.
Many people hesitate to wear a button because they worry about "bothering" someone. A quick "I'm fine, sorry about that" is all it takes. The same goes for a fall alert you did not mean to set off. Cancel it if the device gives you the chance. If the call connects anyway, tell the operator you are okay.
What does the family see?
Usually, a phone call. When the operator decides family should be contacted, emergency contacts are normally phoned in the order set on the file. Whether family is called at all depends on what happened and on the instructions you chose.
Some systems add an app for family. Holo Alert offers an optional, paid Caregiver App for its Holo Pro device. Approved caregivers can get app notifications for button presses and fall alerts, see the device's most recently reported location, check its battery level and look back at alert history. It shows the latest location the device reported, with the option to request an update, rather than live tracking. The app is not available on Holo Mini or Holo Active. The people on the app also do not have to be the same as the emergency contacts.
If you are the family member who gets that call about a fall, our guide on what to do after a senior falls covers the first few minutes.
A U.S. National Institute on Aging guide makes a fair point here. These systems only help if they are set up correctly and worn. They also cannot replace regular check-ins from family and friends. The button is one part of the plan, not the whole plan.
Frequently asked questions
What is the best personal emergency response system for seniors?
The best one is the one the person will actually wear every day. Compare 24/7 monitoring, whether fall detection is included, whether it works outside the home, battery life, and the contract terms. Our comparison of medical alert systems in Canada lines up the main Canadian providers on those points.
Are there any free medical alert systems available for seniors in Canada?
A device with no monthly fee is usually unmonitored: it dials 911 or your own list of numbers, with no trained operator answering. Help with the cost of a monitored system depends on your province, insurer and eligibility. We looked at what medical alert systems with no monthly fee really include.
Do you need Wi-Fi or a landline for a medical alert system?
It depends on the type. Basic in-home systems run through a base unit on your home phone line. Cellular systems carry the call over a mobile network instead. Holo Alert devices use their own built-in cellular connection, so no Wi-Fi, landline or smartphone is needed. A home power outage does not immediately turn the device off, because it runs on its rechargeable battery. It still needs enough charge and cellular service, and you may not be able to recharge it until the power comes back.
How far from home does a medical alert button work?
A basic in-home system works within your home, near its base unit. A cellular system works wherever it has cellular service. Holo Alert works anywhere in Canada where cellular service is available, and some of its devices also work in the United States, which helps snowbirds who spend the winter south.
Before you need it
The press is the easy part. The plan behind it is what you can shape today: who is on the list, in what order, who has a key, and what the operator should know. Sit down with the person who will wear the button and write that list together. Then make one test call, so the first real call is not their first call.
If you would like to see how one Canadian provider handles the call, you can learn more about how Holo Alert monitoring works.
