Living alone can be tough for seniors. Some don't have family nearby to check on them, and they worry that if they fall or suffer a medical emergency and can't get to the phone to seek help, no one will know.
That's why hundreds of police agencies in small towns, suburbs and rural areas are checking in on seniors who live alone by placing an automated call to them every day.
Police officials say the calling systems, which are fairly inexpensive and easy to use, provide an important service to a senior population that is expected to grow to 65 million nationwide by 2025. Already, nearly half of women age 75 and older live alone.
Advocates for older people say telephone check-in programs can help seniors remain independent in their homes and give them - and their family members - peace of mind.
"It helps ensure for the elderly person or their family that a phone call is being made every morning, that everything is OK. We've gotten incredible feedback on this program," said Cmdr. Jack Vaccaro of the Lighthouse Point Police Department in Florida, which has nine seniors in its automated daily-call program.
Such automated systems began nearly three decades ago. They now are used by police departments from California to Massachusetts. Some police agencies take a more personal approach, using volunteers or dispatchers to place the calls.
Police departments are becoming more sensitive to the needs of older adults, said Sandy Markwood, chief executive of the National Association of Area Agencies on Aging. For instance, she said, her organization is training officers in how to handle seniors with dementia. Telephone check-in programs are one way of doing that.
"I think we're seeing a trend with these types of programs, particularly in rural and smaller communities," she said. "It's a wise use of government dollars for first responders."
Seniors who sign up for telephone reassurance programs decide when they want to be called. They also are typically required to give police the name and phone number of an emergency contact.
Participants get a computer-generated phone call every day - sometimes recorded by the police chief or sheriff - that asks them to press a certain number if they are OK. If they don't answer the phone, they'll get another computer-generated call, and sometimes additional ones.
If they still don't answer, police usually will try to get in touch with their emergency contact before dispatching an officer to the home to check on them.
Seniors who know they're going to be out when the phone rings at the specified time are supposed to notify police in advance. But sometimes they forget, and dispatchers end up sending out a unit on a false call. While that does happen, police officials say it's not a frequent occurrence, so the personnel costs are minimal.
Some agencies, such as the police department in Winter Park, Florida, also require participants to put a house key in a secured box - similar to boxes used by real estate agents - somewhere outside the house. Emergency responders know the code and can open the box and enter the house if necessary.
The price tag for telephone reassurance systems varies.
RUOK, the nation's largest source, is used by hundreds of police agencies, according to Bruce Johnson, owner of the Minnesota company that developed and sells the software. It costs about $1,000 to buy and set up, and it has no maintenance fees.
Database Systems, a Phoenix-based data management company that has sold its system to dozens of police departments, charges nearly $11,000 for purchase, installation and the first year of maintenance, company vice president Jerry Pizet said. After that, most agencies do their own maintenance.
Winter Park Police Officer Randall Morrissey said his agency uses RUOK software that runs on an old laptop and was paid for with forfeiture funds. Running the program doesn't cost the department anything, he said, other than the expense of sending out an officer on a false call, which isn't often.
"A lot of the seniors who sign up are concerned that they could pass and not be discovered for days," Morrissey said. "With this program, it's comforting for them to know they could be found."
That was the reason the Belton Police Department in Texas launched its telephone check-in program in 2013, according to Detective Sgt. Kim Hamilton. The impetus: an incident in which officers found an elderly woman who been had been dead on the floor of her home for at least two months.
"That alone spoke volumes to us," Hamilton said. "We knew there was a need to check on our senior residents."
The check-in programs are less common in big cities, where large numbers of people might sign up, potentially straining budgets because more officers would be needed to check on seniors who don't answer their phones.
But in small cities and towns, suburbs and rural areas, the programs can be more manageable.
"It's economy of scale," said Capt. Larry Murphy, of the Biloxi, Mississippi, Police Department. "If you're in a really large city, you'd have to add more and more resources."
In Biloxi, a city of about 44,000, only 14 seniors are registered. While many police departments want to sign up as many seniors as possible, Murphy said his tries to limit its program to "people who really need it rather than those who just want it."
Murphy said the system has experienced some outages in the past few years because of lightning damage to the dispatch center. That means dispatchers sometimes have to call each senior, which is "resource-intensive but manageable" with a limited number of participants.
Some police agencies that once used automated check-in systems, such as those in Brentwood, Missouri, and Amherst, Massachusetts, have stopped using them. Agencies that choose to give up the systems usually do so because participants move away or die and not enough seniors sign up to replace them.
Police officials agree that for telephone reassurance programs to succeed in the long term, they need to be continuously marketed. Some departments do that by publicizing them on websites, at senior centers and in apartment complexes and churches.
Some police agencies go beyond automated check-ins and use staff or volunteers to dial up seniors and talk to them one-on-one.
Every weekday morning, a staffer at the Orangeburg County Sheriff's Office in South Carolina makes 50 to 60 calls to see whether seniors in the reassurance program are okay.
In Belton, 130 seniors get an automated call every weekday except Wednesday, when they get a live call from one of dozens of volunteers, according to Hamilton. "Sometimes that's the only person the senior talks to that week," she said.
A part-time coordinator oversees the volunteers and is paid through a grant from the Area Agency on Aging of Central Texas. This year's grant was for $21,000.
"Considering what the police have to deal with every day, this is totally the opposite end of the spectrum," said Pam Patterson, an area agency contract manager. "It gives them an opportunity to really help seniors."
And in Belton, as in some other parts of the country, police say the program has saved lives.
Belton police have had four "saves" so far, Hamilton said, including a man who fell to the floor in his house and stayed there from Friday, after his last check-in, until Monday, when his next call came.
In San Diego County, California, one of the bigger areas to run a call reassurance service, the sheriff's department's program goes far beyond automated calls. As part of its You Are Not Alone effort, 452 senior volunteer patrol members call 334 older adults at least five times a week and visit them at least weekly.
"We think the personal touch is a little bit better, in the event something else is going on," said Sgt. Monica Sanchez. "Our senior volunteers are trained to see if there is food in the fridge or if there are signs of neglect. An automated program would not work for us. We like to observe and report."
Sanchez said the volunteers have helped save people's lives, such as when they visited the home of an 86-year-old woman last year, got no response and noticed her mail had been piling up. They contacted deputies, who climbed through a window and found the woman on the floor, severely dehydrated.
"They were just in time to save her life," Sanchez said.