Twenty years of the life-saving little red button

At 90 years old she gives a strong impression of remaining very lucid and eloquent, but time has left her with more ailments than are apparent to the naked eye.

Ana María Perraut (born in 1933 and originally from Malaga) was a determined, independent woman, daunted by very little ... until the near-fatal accident suffered at home last year. Apart from some outside help with housework, she has always lived alone since she settled back in Malaga a decade ago after 44 years living in the UK.

Her daughters continue to live there but, after being widowed, she thought that the time had come to return to her birth city. Since then, and although she lives by herself, she never feels totally alone.

She always has "company" - 24 hours a day, 365 days a year. There is no one physically with her but, at the other end of the red button that hangs around her neck, there are 250 people in Malaga willing to listen to her, guide her, comfort her and to move mountains if necessary if she asks for help, no matter what time of day or night.

All these people are part of the Andalusian Telecare Service (SAT), 20 years in operation since it was first set up in Seville, then later (2006) in Malaga, with its headquarters in the Andalusian Technology Park (PTA). This project of great social significance has gone from attending to 144 people in its first year, to the current 256,268 across Andalucía. Today, in Malaga province alone, there are 42,107 registered users, although since its launch, more than 97,000 people have used the services.

Ana María Perraut had always trusted that remote device, but she had also harboured the hope that she would never have to use it. However, just before Easter last year, she had no choice, despite having tried by her own means to overcome the crisis she found herself in. She had fallen to the floor while cooking. The oil that she had put in a pan on the hob was rising in temperature as Ana María made an unsuccessful effort to get up.

"I tried to by grabbing hold of a drawer, but I have an artificial knee and the strength in my legs failed me. I couldn't reach the hob to turn it off and in the end, for fear of the whole house catching fire, I ended up pressing the red button for the first time in my life," she explained.

While Ana María was being given reassurance over the phone, the SAT operator tried to locate her emergency contacts, but neither her neighbour's nor her sister's phones were picking up, forcing them to alert a fire crew, who had trouble gaining entry through a window. Meanwhile, the smoke was getting thicker in the house but the telecare operators encouraged Ana María to summon the strength to crawl from the kitchen while she desperately waited to be rescued.

Eventually, the firefighters were forced to break down the front door and Ana María lived to tell the tale.

"I have no words to thank them for what they did for me. And also the police, who escorted my sister's taxi to my house after they managed to locate her and all while the city centre was cut off to traffic for the Palm Sunday processions," she said.

Although in the end they got there on time and Ana María appeared to be unhurt, some days later they found that she had two broken ribs - and a fear in her mind that continues to this day. For this reason, she relies not only on her mobility walker, but also on the person who accompanies her 24 hours a day. Despite all that, she still will not part with the pendant that saved her life. "At first this gave me independence, because even when alone, I could ask for help if I needed it, but now, above all, it gives me peace of mind," she said.

In addition to the immediate response in the case of a real emergency, the telecare service goes way beyond just attending promptly to user requests.

In Malaga this year nearly 3,000 calls per day are being handled, of which 33% are incoming calls and 67% outgoing. The work continues with follow-up calls to find out how the user is after an incident. Other calls are to remind users of their daily meds to take or a medical appointment, to offer advice about benefits and any other procedures to do with public services, to wish them a happy birthday or even just to listen when a user has called in simply because they feel lonely. This latter type of call represents almost 30% of the total.

"Some call us simply to tell us about their day-to-day life, to let off steam or to ask us about things as trivial as what might be the winning number for the ONCE ticket draw for that day. There are also those who contact us on New Year's Eve to feel that they are with someone as they eat their grapes. We are here for that, to lessen that loneliness," said Valeria Chianello, head of the telecare centre in Malaga.

Although the service is aimed primarily at the over-65s, anyone in a situation of dependency on others for their care can also apply. Depending on their degree of dependency and abilities, the service is provided directly either to the dependent or their caregiver. In addition, those people between the ages of 16 and 65 with a recognised disability equal to or greater than 65%, and who are registered in any municipality of Andalucía, can also benefit.

Currently, 71.5% of users receive the service for free. The rest pay a monthly fee of 3.60 or 10.80 euros, depending on their financial resources and their personal situation.

In addition to the basic device, which consists of the home unit (its installation and maintenance are free) and the remote push button or red button, there is a mobile telecare alarm system that allows the user to leave home and yet still be found by GPS. In addition, this telecare service can be bolstered by two additional devices to detect gas or smoke at home so that, should a leak occur, an alarm will go off at the telecare centre. Also from the centre they can raise the volume of any home unit and activate the loudspeaker if, in the event of a call, the user takes too long to answer. This way they can quickly rule out if anything has happened to them.

"All this allows them to live alone but without feeling alone, because on the other end of the line they will always have someone to turn to. It enables autonomy that would not otherwise be viable for the user and it also creates enormous peace of mind for their relatives," said Chianello.

This was the case with María Antonia Rodríguez (born in 1946), also a user of telecare after a cousin spoke with a social worker about getting her such a device. She has lived alone since her mother passed away nine years ago. That sense of loss continues and she opens her eyes every morning with the weight of depression upon her.

"I miss someone listening to me." This is her cry for help as she takes solace in the affection that her four cats show her. "They understand me better than people," she said, as she praised the "commendable" work they do from telecare.

"If I am alive today it is thanks to them," stated María Antonia who, on 3 January this year, tripped over an exercise bike at her home and fell face-first to the ground. Dazed, bleeding from the nose and unable to get up due to her problems with osteoarthritis and osteoporosis, for the first time ever she decided to press the red button that she always carried with her.

"In a matter of minutes they had referred me to the Local Police, who were able to access my house through my neighbours' patio. They whisked me away in the ambulance, but thank God it just gave me a scare," she said.

That accident only brought her spirits down further, even though the telecare service regularly calls her to see how she is doing.

"I am very grateful because getting up every day to utter silence is awful. The day after the accident, I called because I felt that I had not thanked them enough for how I was treated by them all, but since then I have not called because I do not want to trouble them or make a nuisance of myself," said María Antonia, acknowledging that having the red button close by feels "more secure".

Both these women fit the majority profile of the service's registered users. That is, eight out of every ten users are female, with an average age of 82, living alone.

Over the course of these 20 years, growth has not only been in the number of users, but also in the infrastructure and the human resources needed "to respond to this growing demand", said Chianello. While the elderly were the first to benefit from the service, those with disabilities were added and finally, after the dependency law came into force in 2007, other people in a situation of dependency could join. "This law marks a milestone in the telecare service by including it in the catalogue of services available for dependency care," stated Chianello.