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The Unbiased Guide to Choosing a Medical Alert System

My mother refused to wear her medical alert pendant. She left it in the bathroom because if she “did fall down, it would most likely happen in the bathroom.”

As important as medical alert features are, there’s one feature no one else talks about. The most important medical alert feature whether the owner will use it correctly. You have to have the medical alert button on you for the system to work.

Like my mom, I’m not sure I’d want to wear a pendant. I don’t wear rings, bracelets or necklaces. So be self-aware when purchasing your medical alert.

Do you want fall detection? To get the best results, a pendant works much better than a watch. If you put that pendant in your pocket, it’s just not going to be an effective fall detection device anymore.

Be honest with yourself. Commit to wearing the pendant. Nothing is more important to our senior independence than avoiding that last fall before the nursing home. Get the alert, wear the pendant, and be grateful that this technology can prolong our healthy lives in our own homes.

How is This Guide Unbiased?

This article does not look at who has the best emergency alert. We’re not looking for the best features, the lowest prices, or the best reputation.

I wrote this article before I wrote any of the product reviews. This article is about how to choose a medical alert, regardless of the brand.

This is the research I do for myself. It’s the research I would have done for my mom if she had asked me to get her a medical alert.

You might be surprised at what a good consumer you will be after reading this guide to medical alerts.

You will learn about:

  • medical alert operator services
  • alert telephone connections
  • home alerts
  • mobile alerts
  • pendants
  • wrist buttons
  • fall detection
  • location detection

Use the Senior Home Central Medical Alert Quiz to find the right device for your needs. Take the Quiz.

What is a Medical Alert System?

A Medical Alert System is device that connects the user to a dedicted medical emergency operator. It’s a quick way for seniors to get medical help. That help can be emergency services, but it can also be a call on your behalf to a caregiver who will come over to help you.

How to Call for Help

A home call box alert has a button you can press to start a call. It will also come with a wearable button. When you push the wearable button, it sends a signal to the call box to start a call. Home box wearable buttons are not communication devices. They just send a signal to the call box to make the call.

A mobile pendant is both a button and a dedicated phone to the alert company. When you push the pendant mobile button, the pendant calls the alert company. The pendant has a speaker and a microphone, just like a regular phone.

Home and Mobile Devices

A home medical alert uses a stationary call box to call for help. A call box uses a landline, a Voice Over IP (VoIP), or a cellular phone network to make the phone call. Call boxes are stationary devices that provide coverage only at your home.

A mobile medical alert uses a wearable pendant to call for help. It uses a cellular signal to make the phone call. Mobile alerts provide coverage so long as you have a cellular signal.

The Home Medical Alert Call Box

Push the button on the pendant or on the base station call box to initiate a call with the alert company operator.
Push the button on the pendant or on the base station call box to initiate a call with the alert company operator.

A medical alert call box (also known as the “base station”) is a communication device in your home. It is like a telephone with very sensitive microphones and a speaker.

A call box works only in the home. It’s not a mobile device. When you activate the call box, it makes a call to the medical alert company care center.

The call box uses your home phone landline or the alert company's cellular phone service to communicate with the operator.
The call box uses your home phone landline or the alert company’s cellular phone service to communicate with the operator.

You can press the call box button, or you can use a wearable button. The wearable button signals the call box. The call box then makes the call to the medical alert company.

The pendant button activates the call box just as if you had pressed the call box button itself.
The pendant button activates the call box just as if you had pressed the call box button itself.

What if you’re in a different part of the house than the call box?

Medical alert call boxes have sensitive microphones and loud speakers. They can  pick up your voice from hundreds of feet away.


The home pendant
This pendant button activates a home call box
A wrist button that activates a medical alert call box
This wrist button activates a home call box

Use the wearable button when you are at a distance from your home call box.

The wearable buttons are not communication devices. They activate the call box or mobile device.

Press the wearable button to send a signal to the call box. The call box connects with the medical alert company.
Use the wrist or pendant signal button to initiate a call from the call box.

The Mobile Device

A mobile medical alert device
A mobile pendant is a two-way communication device. Press its button to call the alert company operator for help. Speak to the operator using the pendant. No call box is required.

A mobile medical alert device is like a very small cell phone. It has one button, a microphone and a speaker.

Press the mobile device button to call for help. The device uses a cellular phone signal to call the medical alert company.

Push the pendant button to call the medical alert operator.
The pendant is a phone that calls the medical alert operator.

Some mobile alerts come with wearable buttons. The button activates the mobile device to make the call. The wearable button is not a communication device. It just activates the mobile communicator.

Press the wearable button to activate the mobile device.
You might wear the signal pendant, but put the mobile communicator in your purse or pocket. If you have an emergency, you press the pendant to activate the mobile communicator. The communicator calls for help. If the communicator is out of voice range (in your purse), the operator will assume you are having an emergency, and act accordingly.

Use the wearable button if you can’t reach your mobile device. The button will activate the call. If the operator cannot hear you, she will assume you are having a medical emergency.

You can use the mobile communicator as a home medical alert. The advantage of using the mobile alert at home is having only one system for both home and away. The disadvantage is that you have to carry the mobile communication device. It is a bit heavier and clunkier than a  pendant button you use with a home device..

Home call boxes have powerful microphones and speakers. They’re designed so that you can use them to communicate even if you’re hundreds of feet away. Mobile communication devices are similar to cell phones. You need to have the mobile communicator near you to hear it and to be heard through it.

How Medical Alert Devices Communicate

A home medical emergency call box.
A home medical emergency call box uses your home phone or the medical alert company’s cellular signal to connect

Home medical alert call boxes communicate over landline or cell phone networks. The landline can be a telephone line or a Voice over Internet Phone (VoIP) line. You might have VoIP if you get your phone service from your cable TV company.

Call boxes work in the home. Even if an alert uses a cell phone network, the call box is still a staionary device in your home.

Call boxes give you protection anywhere from zero to 1,400 feet away from the call box. The maximum distance depends on the model.

Landline Call Boxes

Landline phones usually plugin into a wall socket like this one
Landline phones usually plugin into a wall socket like this one

Original medical alert systems relied on landline telephone connections. These setups are still popular today. Using a medical alert on your home phone line does not interfere with your phone service.

The landline option is usually less expensive than the cellular phone connection.

Internet as Voice Over IP (VoIP) Call Boxes

Most medical alerts that use the home's phone line will also work with VoIP phone systems that use your home's internet for phone service.
Most medical alerts that use the home’s phone line will also work with VoIP phone systems that use your home’s internet for phone service.

If you have phone service from your cable TV company, you probably have a VoIP (Voice over Internet Protocol) phone system. This looks like a landline system, but it gets its communication ability from TV cable wires rather than telephone wires.

As far as using a call box is concerned, there is usually no difference between a VoIP and a landline phone service. A landline call box uses a telephone jack to plug into a telephone wall socket. VoIP usually uses the home’s landline wall sockets.

Cellular Call Boxes

Despite using a mobile phone signal, cellular call boxes provide medical alert coverage at home, not away from home. A cellular call box is not a mobile device. It’s a home device that uses a cellular signal.

The medical alert company provides the cell phone connection as part of its monthly fee. Medical alert companies contract with Verizon, At&T, and T-Mobile to sell cellular service to their customers.

How Mobile Medical Alert Devices Communicate

Mobile devices work in the home and away from home.  Mobile alerts use a cellular network signal to call the alert company for help. A mobile alert has coverage as long as you have a cell phone signal.


Cellular signal
Cellular signal

The Fall Detection Auto-Call Feature

Fall detection is a trigger that calls for help if it senses you have fallen down. Not all medical alerts come with this feature.

Fall detection automatically detects falling movements
Fall detection automatically detects falling movements

For the fall detection to work, you must be wearing a pendant. This can be a home signal pendant or a mobile two-way communicator pendant. But it has to be a pendant. It can’t be a watch or a device you put in your pocket.

Fall detection pendants contain gyroscopes and a tiny computer to calculate if the movement it senses represents a fall. This technology works best in a pendant, because  a pendant swings as you move. Wrist buttons and devices in your pocket or purse don’t move enough to create good fall detection devices.

Some watches such as the Apple Watch include fall detection technology. It is not as accurate as pendant-based fall detection devices.

Fall detection is an excellent safety net technology, but it’s not perfect. Three issues to be aware of are the possibility of:

  1. fall alerts that you have fallen when you have not fallen
  2. failure to alert that you have fallen when you have fallen
  3. the medical alert user defeating the purpose of the fall detection technology by cancelling the call fo help

Fall Detection False Positives

A fall positive occurs when a  fall detection device reports a fall, but you have not fallen down. If a movement triggers a call, you can cancel the alert. Just say “false alarm” when the operator answers the automatic call.

Fall Detection False Negatives

A false negative occurs when the fall detection fails to trigger but you have actually fallen down. It doesn’t matter which medical alert brand you get. The technology is 95% accurate. 5% of the time, you might run into this situation. If you fall, check to see if the fall detection triggered. Press the button for help if it did not. This doesn’t happen often, but it is a possibility of which you should be aware.

Fall Detection Compliance Issues

For the fall detection technology to work as intended, the user has to follow through with the automatic call.  Many caregivers have reported that their patients have fallen but have then cancelled the automatic call for help. The patients later reported that they did not want to be a bother to emergency personnel or family.

The best way to handle non-compliance is to prepare for it in advance. Find out exactly what will happen should a fall trigger a call for help. You have control over what will happen. When you sign up for service, you give instructions to the medical alert company. You can say “Only call 911 as a last resort.” You can give names and numbers of other caregivers to call ahead of emergency services.

“Not wanting to be a bother” is a great way to stay injured when you need help. The fear of getting help might be related to the costs involved, or worrying about bothering people for help. If you plan for the event ahead of time, you will have the confidence to follow through with getting the help you need.

Who Responds to Your Emergency

Your call for help goes to the medical alert care center, where it is dispatched to the people or agencies who will come to help you.

Call Center Operators

Medical alert operator
Medical alert operator

Medical alert companies employ call center operators to answer their customers’ calls. The operators use your filed instructions to decide who to contact when you need help.

Not every call requires an emergency system response. Sometimes it is better to have a caregiver, neighbor, relative or community member to attend to your problem.

The Call Center Operator dispatches your problem to the right person for the job.

Part of your monthly fee pays for the call center dispatch service.

Caregivers, Friends, and Family Helpers

Elderly emergency help
Elderly emergency help

When you sign up with a medical alert company, they will ask you for a list of caregivers and contacts.

Your list should include names, phone numbers, relationships, availability, abilities, and access.

Your instructions might look like example:

  1. Jane Smith, 666-555-5555, Mon-Fri 6pm-12am, Sat-Sun 8am-12am. Call in an emergency as she has a key to the house to give to the 9-1-1 responders. Primary person to call if I don’t need 9-1-1.
  2. ABC Caregiver Agency, 555-555-5555, 24 hours a day, 7 days a week. Contact if I ask for their help, otherwise, do not call them. They have a key to my home.
  3. Otherwise call 9-1-1

If your primary caregivers can’t respond, you can opt to have the dispatcher contact local emergency services.

Lock Box

Lock box with keys
Lock box with keys

A lock box is a little safe that attaches to your front door knob. You can put a key inside, and then give your medical alert company the combination. When you call for help, the operator will give your responder the combination. This is particularly important if you call 9-1-1. They will break your door (or window) if they can’t get in with a key.

Location Detection

Most mobile medical alert devices include Location Detection. They use GPS (Global Positioning System), or similar technology, to figure out where you are.

This feature acts as a location beacon. You don’t need to know where you are. The medical alert company will find you, and convey your location to responders.

The Location Detection is also helpful for wanderers, but only if they are wearing their mobile device when they leave home. Since some people wander in their pajamas, this can be a challenge.

Medication Reminder

Some medical alert plans include a medication reminder service. You program a wristwatch or pill caddy to remind you when it’s time to take some pills.  The Pill Caddy is the more effective device because it can offer up the pills to take with each alarm.

Overcoming Medical Alarm Limitations

No medical alert is perfect. You might forget to wear your button, or to charge your mobile device. Here are some ways to increase medical alert success.

Increasing Wearable Button Success

Get a water resistant or waterproof pendant and wrist button with your home device. This way you don’t have to take it off when showering.  This is a good solution so long as you wear the button all the time. It will only work in an emergency if you can reach it, which usually means you need to wear it. If you fall, you’d have to be very lucky to be right where you left the button.

Increasing Wristwatch and Mobile Device Success

Create a charging schedule for your wristwatch or mobile device. If you can get a wearable button to activate the device, you can wear that while the device is charging.

Increasing Call Box Button Success

Another solution is to put multiple call boxes throughout the house. It’s still unlikely that you’ll fall within arm’s reach of a box, though. The best way to get help is to always have your wearable button or mobile device on you.

Why Not Just Use the Phone?

A medical alert is dedicated to getting you help in an emergency. Your call for help goes to a medical alert company, where an operator helps get the right people to your location.

The “right” people might be different, depending on your situation. You can leave instructions with names and phone numbers on file.

For example, let’s say you are unable to get out of bed, and need your medicine in another room. You press your emergency button for help. The operator asks what is wrong, and you explain that you need a friend to come over to help get your medicine. The operator will then call the friends on your list until one answers and agrees to help you. The medical alert company makes all the calls on your behalf, while you rest.

Or, let’s say that you are having debilitating chest pains, or you have fallen down. You are in trouble, and you can’t reach the phone. You press your emergency button for help. You tell the operator that you’re having a medical emergency. The operator calls your local 9-1-1 service.

With a medical alert, you can get emergency help even if you can’t speak. If you press the button and then don’t say anything, the operator will assume you are in trouble, and will call the emergency contacts on your list, or 9-1-1.

Neither landline nor cell phones can perform these services for you. This is why a medical alarm is better than a telephone.

How to Buy a Medical Alert System

Each Medical Alert System feature responds to a user need. To determine which features you need in your Medical Alert System, compare your situation with each feature’s benefits. You can then match the features you need in your system with systems available on the market.

Use the Senior Home Central Medical Alert Quiz to find the right device for your needs. Take the Quiz.

Choose Internet/VoIP/Landline vs. Cellular Network Communications

Using a landline or VoIP (if that’s what you have at home) is cheaper than using a cellular connection.

However, better features such as fall detection are sometimes not available on landline call boxes.

You might get a cellular call box device even if you have a landline or VoIP phone service. Personally, I would only get a fall detection medical alert, even if that meant using the alert company’s cellular network rather than my home VoIP phone jack.

Wear Belts and Suspenders

Wear a pendant and a wrist button for your home system. You’re more likely to have at least one on you if you need it.

If the company offers it, get a pendant for your mobile system. Wearable buttons are lighter and smaller than the mobile devices.

If the pendant idea bothers you, consider getting a smart watch medical alert. Then you get a cool watch with no hint it’s a medical alert device on the outside.

Takeaway: You’re more likely to press the emergency button than to dial the phone, so long as you’re wearing your button.

“Don’t Fall”

I always said that to my mother when we were hanging up. “I love you. And don’t fall.

Her medical alert pendant was usually in the bathroom, where it would do her no good if she did fall.

Falling is a huge risk. Cemeteries are littered with the broken hips.

I cannot think of a better solution than medical alert Fall Detection.

For Fall Detection to work, you must have the pendant (or sometimes, the watch) on you when you fall.

It works off your movements.

The device will automatically call the medical alert company when it senses a call.

If you are OK, you can just say that to the operator, and it will cancel the alert.

But if you hit your head and therefore don’t push the button, it’s a nice safety net to have the Fall Detection service.

Just be aware that the Fall Detection technology is not yet perfected. It will sometimes call when you don’t fall, and it will sometimes miss that you have fallen.

Take a Quiz to Find Your Medical Alert

(Added Dec. 10 2019)  We have published two quizzes so far, and we’re adding more soon. Use these quizzes to find the features you want in your medical alert.

Go to the MobileHelp Quiz

Go to the Alert1 Quiz

People Also Ask

“If I need emergency medical help at home, why not just use my landline phone to summon help?” To use a landline phone as an emergency alarm, you have to be able to reach it. You might not be able to reach the phone. You have a much better chance of being able to press the button on your pendant or wrist than getting to the nearest phone.

“If I need cellular technology for my mobile service, why can’t I just use my cell phone for medical emergencies?” Cell phones do not send your identity, your history, or your caretaker list to emergency services. 9-1-1 doesn’t call your contacts even if you do give them a list! The medical alert service is more than just a 9-1-1 dispatcher. It keeps info on hand like who has a key to your home, and whether you prefer friends and caretakers to help when they can.


Medical Alerts We Like

The home pendant automatically calls for help if you fall. (Fall detection technology is not yet perfected. Always press the button if you can, to be doubly sure the device calls Alert1 for help.)

The Alert1 Home Fall Detection Medical Alert

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The home wrist button

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The Alert1 Pro On-the-Go Fall Detection Medical Alert

The Alert1 Pro On-the-Go Fall Detection Medical Alert System communicates with Alert1 over a cellular device which is packaged as a pendant ...
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MobileHelp Classic Medical Alert

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A pendant button and the mobile devices it activates

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Push the button on the mobile device or the pendant.

The MobileHelp Solo Medical Alert

MobileCommunication PendantSignal PendantSignal WristFall DetectionLocation Detection The MobileHelp Solo is a mobile-only medical alert. It does not have a home base station ...
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MobileHelp Wired Medical Alert

The MobileHelp Wired Medical Alert

Home Call Box Landline Signal Pendant Signal Wrist Fall DetectionThe MobileHelp Wired medical alert system provides emergency coverage in your home ...
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