A Survey of Telecare Systems in Poland

Grażyna Grabowska, Katarzyna Kaczmarek, Jan Owsiński, Izabella Zadrożna and

Olgierd Hryniewicz

Systems Research Institute, Polish Academy of Sciences, Newelska 6, 01-447, Warsaw, Poland

Keywords: Telecare Systems, Personal Alarm Systems, Assisted Living, Survey.

Abstract: In view of the demographic changes, the need for new telecare technologies is clearly growing. At the same

time, in Polish law, there is still no provision allowing for the financing of the telemedicine and telecare

services by the National Health Fund. The aim of this contribution is to survey the state-of-the-art telecare

systems available on the Polish market and to discuss the main related problems. We also present results of

interviews carried out in Social Welfare Centres. It turns out that the telecare system matching most of the

identified key needs is not yet available on the Polish market.

1 INTRODUCTION

Statistics of the ageing of our societies are alarming.

In 2015 the share of the elderly (75+) in Poland is at

roughly 7% of the total, and, according to forecasts,

it will increase to 11% in 2030, and to 13.5% in

2045 (GUS, 2015). Furthermore, as predicted within

the Health for Growth Programme by the European

Commission, in 2020 there will be a shortage of one

million health workers in the EU and, should no

action be taken, 15% of the necessary care will not

be covered. Therefore, Information and

Communication Technologies (ICT) solutions are

needed to tackle workforce shortages and to

maximize the efficiency of the health and care

systems.

Hopefully, ICT tools may not only support the

functioning of the health and care systems, but also

address the proactive needs of the ageing societies to

improve the quality of life. The list of the state-of-

the-art ambient assisted living solutions is extensive,

see (Lara et al., 2013). Artificial intelligence is able

to handle and process big data coming from

inhomogeneous and uncertain sources including

signals retrieved from sensors. Signal analysis and

anomaly detection are only some research problems

that may be addressed with fast growing machine

learning tools, see e.g., (Banaee et al., 2013, Sow et

al., 2013, Mannini et al., 2010). An interesting

approach to human activity recognition, basing on

video recordings and adapting the fuzzy

methodology has been proposed by (Díaz-Rodríguez

et al., 2014).

The main goal of this contribution is to survey

the state-of-the-art telecare systems available on the

Polish market and discuss the main related

problems. We have investigated them by performing

an introductory survey and interviews in Social

Welfare Centres. Basing on the performed survey, it

turns out that the development of the telecare

systems in Poland is significantly slower than

generally in Europe. The results of this survey show

that the telecare system matching all the identified

key needs is neither common nor easily available in

Poland, not to mention the fact that it is not freely

available or financed with public funds.

It needs to be stated that the focus of this paper is

not to provide an exhaustive and systematic review

of scientific publications related to the ICT

solutions, but rather to survey the telecare systems

that are deployed on the Polish market. The national

focus of this study is justified by (a) important

differences among countries as regards the

demographic situations, not only in sheer numbers,

but also in family structures and relations; (b) very

deep differences in the systems of health and social

care; and (c) important differences in wealth of

citizens, as well as the capacities of the health and

care institutions.

The structure of this paper is as follows. In the

next Chapter, we describe the telecare systems

available in Poland. In Chapter 3, we describe our

290

Grabowska, G., Kaczmarek, K., Owsi

nski, J., Zadro

zna, I. and Hryniewicz, O.

A Survey of Telecare Systems in Poland.

DOI: 10.5220/0005699702900297

In Proceedings of the 9th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2016) - Volume 5: HEALTHINF, pages 290-297

ISBN: 978-989-758-170-0

survey on desired characteristic of a telecare system

and discuss the related challenges. Chapter 4

presents conclusions and an outline for future

research possibilities.

2 TELECARE SYSTEMS

Among many applications of telemedicine, the

telecare system is the most associated with primary

care for the patients. The telecare system refers to

the automated support of social care at home. It is

focused on monitoring the vital signs or potentially

harmful situations (e.g. falls, night wandering,

flooding with water, smoke, gas) and automatic

reporting to the monitoring centre, see e.g. (Tchalla,

2012, Turner and McGee-Lennon, 2013).

2.1 Telecare Generations

In the literature, three generations of telecare are

distinguished, see (Stowe and Harding, 2010). The

first generation telecare denotes the simplest

devices, which are composed of a transmitter with a

button alarm (worn on the wrist as a bracelet,

strapped to the belt, or as a pendant around the

neck), a terminal with the function of initiating a

call, and the operation centre, to which the signal is

sent. Users themselves must activate the alarm by

pressing the alarm button in order to obtain help.

However, the system becomes ineffective when the

telemonitored person is unable to raise the alert

(Majeed and Brown, 2006).

The second generation systems consist of more

advanced devices, automatically notifying of the

potential hazard, with no need for the telemonitored

person to trigger the alarm. There is a wide range of

available sensors detecting smoke, carbon

monoxide, temperature, flood or fire, automatically

sending information to the operation centre and

initiating the necessary response. In the case of a fall

or any unusual behavior, other than described as an

individual user characteristic (e.g. hours of sleep,

taking a medicine), the system automatically calls

for help.

Third generation systems include the most

advanced devices, offering the possibility of

automatic data collection on everyday activities of

the telemonitored person. Complex sensors and

biosensor systems allow for continuous monitoring

of the physiological parameters (body and skin

temperature, blood oxygen saturation, heart rate,

EEG, EMG, blood glucose, mobility, activity, fall)

and individual behaviors (Chan et al., 2012). When

the bio parameters deviate from the norm, the alert is

sent to the user, his/her relatives and carers. An

interesting discussion on smart wearable systems is

provided in (Esteve et al., 2012).

In Europe, the telecare systems have been

present for decades (Stowe and Harding, 2010). The

three main European funding programmes for 2014-

2020 that include topics related to the problems of

an ageing society are as follows: Active and

Assisted Living Research and Development

Programme (AAL); Third Health Programme and

Horizon2020. Results of the first call dedicated to

the ICT based solutions for Prevention and

Management of Chronic Conditions of Elderly

People can be seen e.g. in (Waterworth et al., 2009,

Belbahir et al., 2011, Kamel Boulos et al., 2009 and

Bourke et al., 2010). Nonetheless, the development

of the telecare systems in Poland seems to be

significantly slower than generally in Europe. In

Poland, the main source of development of

telemedicine services is from the private funds of the

citizens (Bujok et al., 2015).

2.2 Telecare Systems in Poland

In this section we survey the telecare systems that

are available on the Polish market. Our search has

been conducted according to the following

keywords: 'personal alarm systems', 'telecare

systems', 'ageing care' using Scopus, Springer,

Elsevier and the Google search engines. Table 1

presents the resulting summary. These systems are

described in details in the forthcoming subsections.

At the time of this writing, that is October, 2015,

this overview appears to be quasi-complete to the

best knowledge of the present authors. Omissions

might concern the systems under development, not

present on the market, nor publicly announced.

2.2.1 First Generation of Telecare

As shown in Table 1, the most common telecare

solutions are personal alarm systems. The devices

with alarm buttons are offered by various

companies, like MDT Medical, Makamed, MarTom

Security, House Domowa Opieka, RevoApp and

Polskie Centrum Opieki. In the majority of these

systems there is only one, simple alarm button,

initiating a call for help. The MarTom Security

Telecare system has two additional buttons: green

for the case of loneliness and blue if there is a need

to call technical assistance. The first generation

telecare is also offered by Polskie Centrum Opieki,

MDT Medical and RevoApp, disposing of advanced

technologies and more possibilities to protect the

telemonitored people (see 2.2.2), but also offering

the use of simple devices (without sensor

A Survey of Telecare Systems in Poland

291

Table 1: Overview of telecare systems available on the Polish market in October, 2015.

Product/Project System description Type

Telecare

generation

Makamed Telecare

(Makamed Ltd.)

Alarm button Commercial 1

Life Button Sara

(House Domowa Opieka Ltd.)

Alarm button Commercial 1

MarTom Security Telecare

(Martom Security Ltd.)

Alarm, loneliness and need of

assistance buttons

Commercial 1

Home Telcare

(Polskie Centrum Opieki Ltd.)

Alarm button and sensors (e.g.

smoke, gas, fall, leave the room, take

drugs)

Commercial 1

and 2

Neo GSM

(MDT Medical Ltd.)

Alarm button and sensors Commercial 1

and 2

RevoCare

(RevoApp Ltd.)

Alarm button, sensors (temperature,

humidity, CO, pressure, opening

doors, windows, lighting)

Commercial 1

and 2

MobiCare

(MobiCare Ltd.)

Alarm button, GPS, sensors (fall,

lack of exercise, opening the door,

smoke, gas, flooding with water)

Commercial 2

iSULIN

(Military University of

Technology)

Non-invasive measurement of blood

glucose biosensor, wristband

Commercial 3

safeUP

(Gadmel)

Wireless sensors for data collection Commercial 3

SiDLY Care

(SiDLY Ltd.)

Wristband monitoring vital signs,

permanent monitoring health status,

sensors

Commercial 3

DOMESTIC

(Gdańsk University of

Technology)

Heart rate monitor, sensors for

respiratory and physical activity,

blood pressure, temperature and

network monitoring of domestic

events (electricity, water leakage,

light)

Research 2

RADCARE

(Warsaw University of

Technology and Bergen

University College)

Pulse-radar-based system, low-power

radar sensors

Research 3

RAAP

(Warsaw University of

Technology in collaboration with

partners)

Robot attendant Research 3

installation) to call for help. For example, Polskie

Centrum Opieki offers the telecare system

combining both first and second generations.

2.2.2 Second Generation of Telecare

As presented in Table 1, three second generation

telecare commercial products (Home Telecare by the

Polskie Centrum Opieki, RevoCare, MobiCare) are

available on the Polish market. There is also one

research project (DOMESTIC).

Polskie Centrum Opieki is the biggest telecare

company in Poland and it has the largest scope with

about 1 000 active users. The company collaborates

with social welfare centres and provides telecare

systems to elderly people. The telecare system is

partially or fully funded by local authorities. The

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telemonitored person can choose to have only an

alarm button, which, in the case of accident, sends a

signal to the operational centre (first generation), or

additionally, to install various sensors, which detect

smoke, gas, fall or activity, e.g. taking a medicine,

leaving the room. Signals from the sensors are sent

automatically to the operational centre (second

generation).

The RevoCare system is a wellbeing monitoring

device built into a video phone for the elderly, who

live alone at home. The telemonitored people can

use it on the daily basis to keep in touch with family

and friends. This system, besides the alarm button

(first generation), has many other features, such as

voice and video calls, intercom, notifications,

medication reminder, and sensors (second

generation) that detect fall, lack of activity, door

opening, smoke, gas, and flooding with water

(Sokołowski and Stasiełowicz, 2015). The system is

in prototype tests now and it is not yet available on

the market. It is expected to appear on the market in

2015.

The third company offering a second generation

system is MobiCare. The system in the basic version

consists of the fall detector (attached to a belt or

carried as a necklace), motion sensors, door opening

detector, remote control keychain (while the user is

out of the house), central unit, and the call centre.

The system automatically generates alerts when it

detects a fall of the telemonitored person, lack of

movement in the apartment for a long time or door

opening when nobody should be in the house.

Additional sensors that are installed within the

system can detect smoke, gas, fumes or water on the

floor, and trigger an immediate response from the

employees of the care centre. In an emergency, care

centre contacts the telemonitored person to see how

he feels and give him all possible assistance. It can

initiate assistance through contact with family,

friends, neighbors, and, if necessary, call the

appropriate emergency services. There are no data

available about the estimated number of users of this

product.

The DOMESTIC telecare project, dedicated to

home assistance for the elders and disabled, results

from research carried out at Gdańsk University of

Technology. The aim of the project is to develop

solutions using modern technologies to promote

active and healthy ageing. The outcome should be

new organizational solutions, developed prototypes

of devices, and software ready for commercial use

and implementation by cooperating companies,

institutions and organizations. The target group are

the elderly, sick, disabled, people with limited

mobility. A product ready to sell, HARN, is an

enhanced remote controller equipped with the ability

to measure vital signs and to process text or voice

messages/alerts. It measures blood oxygen

saturation, electrical activity of the heart, and

reminds about events or activities. Products in

prototype tests are: PathMon – a wearable

multisensory device for mobile monitoring of

electromechanical coupling of heart and respiration

activity (to measure electrical and mechanical

activity of the heart, electromechanical coupling in

the heart, breath rate, posture and physical activity);

HoAls (Home Alerts System) is a sensor network

monitoring domestic events, such as water,

electricity, water leakage, switching lighting and in

the case of danger, alarm reporting; eBathtub is a

system supporting safe bathing in a bathtub; it uses

measurements of bio- impedance, ECG, water level,

water temperature and others, and is meant to

monitor the activity of a bathing person (e.g.

sleeping), the risk during bath (e.g. drowning), the

water level and water temperature; there is a

possibility of automatic water cut off and water

dump, if dangerous conditions are detected (e.g.

high water level), of automatic triggering and

distribution of alerts (e.g. assistance required, heart

attack, etc.). There are no data available about

estimated numbers of users of this systems, because

of the test stage of this research work.

2.2.3 Third Generation of Telecare

Third generation of telecare is still the marginal part

of all telecare systems, but the research is

dynamically ongoing. Thus, Table 1, accounts for

just a fraction of endeavours in this domain,

focusing on those that are supposed to appear first

on the market. Namely three commercial products

(iSULIN, safeUP and SiDLY Care) are announced to

appear on the Polish market in 2015. Furthermore,

the following two research projects: RADCARE and

RAPP are carried out.

The iSULIN product is developed by students of

the Military University of Technology in Warsaw.

This is a system for monitoring the health hazards of

diabetics. The wrist sensor continuously analyses the

patient's non-invasive parameters: pulse, blood

pressure, blood oxygen saturation and blood sugar

levels. Based on these parameters, the system

examines the patient and informs about his/her

health.

A Survey of Telecare Systems in Poland

293

The safeUP system offered by Gadmel is an

autonomous system for the remote care for the

elderly. The wireless sensors, installed on everyday

usage objects (e.g. doors, first aid kit cabinet, bed)

enable collecting signals and sending information to

the caretakers. The activity or inactivity of the

elderly person is communicated via SMS.

Another project is called Sidly Care and is a

multi-sensory device of medical telematics (the

wristband monitoring the vital signals). The device

is aimed to provide continuous monitoring of the

health status and to archive measurements of data in

a dedicated mobile application, and then send text

message to caretakers. Sidly Care is not yet

commercially available.

The RADCARE project (Care support for elderly

and disabled people by radar sensor technology) is

the result of synergy between the leading Norwegian

approach to care services for the elderly and Polish

technology resources. A pulse-radar-based system

can be used to detect and identify some features of

the human behaviour (entering or leaving the bed,

falling on the floor, revealing an untypical or

hyperactive behaviour, stopping too long in a non-

typical place e.g. in the bathroom) without the

necessity of visual observation of the monitored

person, also in a dark room. The system can be used

for measuring some parameters of the body

functions (pulse, heartbeat, and breathing) in a non-

invasive way by using compact, miniature, safe and

low-power radar sensors.

The RAPP project (Robotic Applications Store

for Delivering Smart User Empowering

Applications) provides an open-source software

platform to support the creation and delivery of

Robotic Applications. These applications will enable

robots to provide physical assistance to people at

risk of exclusion, especially the elderly, to function

as a companion. The RAPP partnership counts on

seven partners in five European countries (Greece,

France, United Kingdom, Spain and Poland),

including research institutes, universities, industries,

and small/medium-sized enterprises. The goal of this

project is to identify the best ways to train and adapt

robots to serve and assist people with special needs.

The RAPP project will help to enable and promote

the adoption of small home robots and service robots

as companions to elderly people.

In general, the telecare systems available on the

market in 2015 seem to be at an early stage of

development with very limited group of users. The

estimated scope, basing on the data obtained from

the companies, show that the telecare systems are

used just by up to few thousand people in the

country, that is, only a minuscule fraction of the

whole population.

3 THE DESIRED

CHARACTERISTICS

We have performed a limited survey in Social

Welfare Centres to investigate the needs for the

telecare system from the perspective of the potential

users. In this Section, we present first conclusions.

The task of the social care is entrusted in Poland

almost exclusively with the local self-governmental

administration, who often dispose of very limited

budgets. Social care services were provided to 88.9k

and 69.8k people in 2014 by respectively, non-

stationary (provided at home of the elderly and the

ill) and stationary Social Welfare Centres in Poland

(MPiPS, 2015). Currently, no ICT system is

deployed globally to support the caregivers and the

caretakers of the Welfare Centers.

The study was carried out basing on a

questionnaire and the interviews performed with the

representatives of 6 Social Welfare Centres (4 in

Warsaw, 1 in Cracow and 1 in Poznan). Questions of

the questionnaire concerned persons 65+ and of

every sex. The questionnaire was followed with the

interviews. The questionnaire focused on the desired

functionalities of the ideal telecare system and their

attractiveness. The questionnaire asked also for the

types of care services, access to these services (in

case of 24-hours Social Welfare Homes), an

acceptable cost of subscription, needs in the nursing

care and evaluations of the psychophysical condition

of elders determining abilities or impossibilities of

independent using telecommunications devices. For

the use in the stationary Social Welfare Centres, the

questionnaire has been slightly modified.

The responders were asked to mark a score (1-3)

determining the attractiveness of the considered

functionality. The outcome of the likes as to the

items and functions for the telecare system is

presented in Figure 1.

As depicted in Figure 1, the top three desired

characteristics for the telecare system, basing on the

information from the aforementioned Social Welfare

Centres are: alarm button (100%), automatic fall

detection (92%) and automatic anomaly detection

(83%). From the point of view of the stationary

Social Welfare Homes, two functionalities are

indicated as most desired: the alarm button (100%)

and fall detection (100%). The remaining

functionalities are indicated as moderately needed.

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Figure 1: Desired characteristics for the telecare system according to the survey in (a) Social Welfare Centres (b) Stationary

Social Welfare Centre.

The proposed functionalities like warning over

threats or the measurement of life parameters are

attractive for both types of institutions. The

interviews showed differences in the expectations

concerning the evaluation of work of the

personel/staff. From the point of view of the Social

Welfare Centres, it would also be very convenient if

there is a possibility of confirming the rendering of

service for the elderly or disabled person by the

respective caretakers. This feature is very important

in the context of assessing the provision of service

and its quality. The confirmation and quality

assessment seem to be important also for the Senior,

who would retain the feeling of empowerment and

contribution to the functioning of the system.

Within the questionnaire, we have also asked

with an open question to indicate the expected

monthly price for the telecare system (including

measurement devices). According to the collected

information, the expected price is 30 PLN (~7.1

EUR) per month for basic features (top 3 desired

characteristics) and 45 PLN (~10.7 EUR) per month

for the advanced version. Such expectation may

become an important constraint when deploying the

telecare solution on the Polish market. It needs to be

stated that this is also a reflection of the wealth

situation of the citizens. Nonetheless, Polish law has

no established definition of telemedicine yet and

there are no legal regulations allowing for the

financing of the telemedicine services by the

National Health Fund. The long-term care for the

infirm and seriously ill elderly people at home

remains mostly with the family.

It also needs to be concluded that during this

study the representatives of various Social Welfare

Entities expressed high demand for some sort of a

telecare system and the willingness to cooperate and

implement it. They are stating their awareness of the

expected alarming changes in the demographic

situation and the readiness to deploy telecare system

of the third generation to support the everyday care

of elders.

4 CONCLUSIONS

In this paper, first, we have surveyed the state-of-

the-are telecare systems that are available on the

Polish market or are readying to enter this market.

Then, we have described the main related problems

and some specific needs for the ICT based telecare

systems from the perspective of elders. We have

investigated them by performing questionnaire and

interviews in Social Welfare Centres.

According to the survey, there are several

solutions commercially available that support the

care of the elderly (mostly first and second

generation telecare systems). The third generations

are developed mostly as prototypes within the

research projects. The telecare systems on the

market seem to be at an early stage of development

compared to the international standards with very

limited group of users. The estimated scope, basing

on the data obtained from the companies, show that

the telecare systems are used just by up to few

thousand people in the country, that is, only a

minuscule fraction of the whole population.

The results of the survey confirm that the

telecare system matching the key needs is neither

common nor easily available in Poland, not to

mention the fact that it is not freely available or

financed with public funds. The long-term care for

the infirm and seriously ill elderly at home remains

mostly with the family. Social Welfare Centres

confirm also the limited pricing capabilities.

Nonetheless, the investments in the telecare systems

are needed to support the functioning of the health

and care systems and for the improvement of the

A Survey of Telecare Systems in Poland

295

quality of life of older people while retaining their

autonomy as human beings

Future research assumes a systematic review of

scientific publications focused on the comparative

analysis of the ICT based telecare systems in regards

to their functionalities, technologies, equipment,

price, international orientation and user interface.

ACKNOWLEDGEMENTS

Publication is co-financed by European Union from

resources of European Social Fund. “Information

technologies: research and their interdisciplinary

applications”, Objective 4.1 of Human Capital

Operational Programme. Agreement number UDA-

POKL.04.01.01-00-051/10-01.

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