The ‘Total Cost’ of finding a citizen with Dementia who has been repor.

Realising The Benefits

White Paper 1 | Finding Vulnerable Citizens | 2024

This White Paper: The ‘Total Cost’ of finding a citizen (with Dementia) who has been reported missing and the cost effectiveness of the CPR Guardian wearable technology watch.

Authors:
Professor Nick Rich
Dr Daniel Rees
Dr Harry Bell

The Problems Associated with Missing Persons

We can all remember what it feels like when a child or an elderly loved one has gone missing. The sense of panic is overwhelming. The negative images of ‘what could’ happen to the missing person run through your mind. It is a horrible feeling of guilt that a vulnerable person, under your supervision, is now missing and could also be in an equal amount of distress.

The reality is people, of all ages and backgrounds, go missing every day. Thankfully most ‘missing persons’ do not experience any significant event beyond distress, confusion, and fear. When the missing person returns there is relief and a commitment to learn from the experience.

We can all sympathise with the people involved with finding a missing person and ensuring their safety but, sadly, it often does happen again because no effective countermeasures are introduced to prevent or reduce the impact of a person going missing again. The “missing person” process is much more complicated and costly than just the high emotional distress described in this short introduction. This white paper will present the true costs of a lost person and the costs of introducing the CPR Guardian watch as a wearable solution. The paper is based on several evaluations conducted by a team at Swansea University to assess the impact of the technology in the context of finding missing persons.

The Stakeholders of the Missing Persons Problem

In the UK, when a person is reported missing, the police are typically the lead agency in the search for the missing person (after a period of time has elapsed). The elapsed time is part of the process to defer allocation of scarce operational police resources to find someone who may well return or be found without the use of officers. When officers are deployed, they will conduct investigations and search for the missing person, often in collaboration with other agencies such as the coast guard if the missing person was at a coastal resort, mountain rescue teams if the person is lost in rugged terrain, and search and rescue dogs/helicopters.

The police may also work with other organizations such as social services, the National Crime Agency, and the Missing Persons Bureau to gather information and coordinate efforts. Family and friends of the missing person are highly likely to be involved in the search, and may be provided with support and assistance by organizations such as the Missing People charities.

The key stakeholders associated with the missing persons process (or ‘Mispers’ – the used by the police to refer to “someone who has disappeared” - source: Cambridge Dictionary). Therefore a number of key stakeholders each will or can contribute to the search and safe return of a missing person. These stakeholders are shown in the table below.

Table 1: Missing Persons Stakeholders

Stakeholder	Adverse Impact	Role in Finding the Missing Person
The missing person	Confusion, potential for harm or abuse, and stress.
The loved ones of the missing person	Stress, anxiety and feelings of guilt. Lost working days as time is taken away from work to find the relative.	Actively engage in search, coordinate family network and liaise with Police.
The carer of the missing person (local community)	Stress, anxiety and feelings of guilt.	Actively engage in search, coordinate family network and liaise with Police.
The Police Service	Assignment of staff and added communications to find missing person and escalate if unfound for a period of time. Distraction from other ‘policing’ duties.	Search for and locate missing person. Ensure safe custody and transfer to secure care destination.
The Tax Payer	The funder of local council and Police Service provision

The missing person is just one individual of many in a nation or region to be lost and require assistance.

Size of the Problem

The motivation to go missing varies widely and varies dependent on the age of the person involved. A significant number of missing persons though have a cognitive impairment of which the most typical underlying cause is the condition of dementia (or associated form of disease). Cognitive impairment means that the individual is unlikely to process data from their surroundings, they will become confused quickly and this confusion contributes to their inability to find a way back to safety.

It is estimated that around 60,000 people with dementia go missing in the UK each year (total UK Population of 67.33mn, 2021). People living with dementia are at a higher risk of purposeful walking (a form of wandering and getting lost), which can be particularly challenging for their caregivers, care homes, dementia frailty wards, family and the authorities. This is a very distressing experience for all involved, and can lead to significant emotional and financial costs. It is important to note that this number is an estimation and can vary depending on the region and the support available for people with dementia and their carers in the UK.

At the rate of 60,000 reported missing persons per year this equates to over 164 missing person reports per day. The problem is therefore a significant one emotionally and financially.

How Long Do Missing Citizens Take To Find?

The length of time it takes to find a missing person (with Dementia) varies greatly depending on the individual case and other factors including the priority rating attached to the case by the Police force (national guidelines) and resource availability. The person's cognitive abilities, their physical condition, the local environment and weather conditions, and the search and rescue resources available can all impact on the length of time it takes to locate a missing person.

In some cases, a missing person with dementia may be found quickly, within a matter of several hours rather than instantly upon detection of their absence. In other cases, the search may take days or even weeks. According to the Alzheimer's society, around 90% of missing people with dementia are found within 24 hours, and 99% are found within a week. However, it's important to note that the longer a person with a cognitive impairment or significant long-term condition is missing, the greater the risk of harm or injury to the person (accidently such as falling, interruption to the prescribed medical regime of the person or malicious as a result of the actions of others – such as robbery). The key priority is for all involved to act quickly and recover control of the situation so as to ensure the safety of the missing person.

Why Do People with Dementia Go Missing?

Lancashire Police Force are a very progressive organisation and have worked extensively to help carers and people with dementia to address the issue of ‘going missing’ and suggest the following causes of such activity. The propose the person suffering from dementia may be stimulated to move and walk through:

continuing a habit that is long engrained in the long-term memory and repertoire of the person
relieving boredom
using up energy
relieving pain and discomfort
responding to anxiety
feeling lost
memory loss
searching for the past
seeking fulfilment
getting confused about the time.

These triggers that lead to a missing persons report/activation of the process are not easy to detect and neither is it easy to manipulate the environment within which a person lives to detect the point where a person with dementia exits their controlled environment and becomes missing without preventing the person from leaving a building.

The Missing Persons Process

According to The College of Policing (the national governing authority on this matter):

“Going missing should be treated as an indicator that the individual may be at risk of harm. The safeguarding of vulnerable people is paramount and a missing person report should be recognised as an opportunity to identify and address risks. The reasons for a person deciding to go missing may be complex and linked to a variety of social or family issues.” (2023).

From the Police perspective, three key factors are considered in every “MISPER” missing person investigation:

protecting those at risk of harm
minimising distress and ensuring high quality of service to the families and carers of missing persons
prosecuting those who perpetrate harm or pose a risk of harm when this is appropriate and supported by evidence”

The process is therefore ‘triaged’ based on urgency and criticality (age, vulnerability, length of time missing, circumstances of disappearance, previous episodes of being a missing person and physical/mental health).

With the important note that the police treat each missing persons case differently and the police response will depend on a number of factors, every missing persons case is allocated to a police officer. The officer will collect initial details and that officer (and their supervisors will conduct a risk assessment to decide the correct response to each case). The decision-making process takes less than an hour (on average) but does involve multiple staff and is based on considerable hours of research by an officer.

The choice of escalation and response will also determine the costs of the process to find the missing person after the risk assessment.

Once the risk assessment has been completed, the officers allocate the necessary resources. As a minimum, the central officer will continue to conduct enquiries to trace the missing person. These enquires are conducted around the clock (multiple shift teams) to ensure the person is found as quickly as possible. For higher risk cases additional resources will be required including specialists (Missing From Home Managers and Police Search Advisors), experts including dog handlers, mounted police and the use of the force’s helicopter service. For instance, Devon and Cornwall police service estimate the costs of using a police helicopter for a missing persons search is approximately £1700 per hour (labour, running costs and insurance). In addition, for the most serious of cases, detectives will be drafted in from the Force Major Investigation Team or specialist Police Search Teams.

The most typical response is to allow the coordinating officer to continue to search and speak to friends and family, checking with known associates and local contacts and may progress to financial enquiries with banks or lenders, telephone billing / call history, for any other clues that may locate the vulnerable individual. Any searches will focus on physically search places or locations where the missing person may have been or may likely be. The case will be reviewed each shift per day and each day by a senior management review team.

What Can Reduce the Time to Find a Missing Person?

The chances of finding a missing person with dementia quickly increases:

If the person has a medical identification with them (this scenario is unlikely given the nature of the person’s condition and the events leading up to their absence. However, such data helps identify them if the carers and family have reported the missing person promptly and have provided accurate and detailed information about the person, such as their physical characteristics and regular areas that they visit.
If the person is wearing distinctive clothing that are visible to searchers which could distinguish their identity when searchers are patrolling.
If the person has an effective means of electronically locating them such as a mobile telephone for communication with a Global Positioning System (GPS). Such devices may be carried on the person or worn by the individual concerned. With cognitive impairment it is typical that non-wearable devices will be forgotten as the confused person loses contact with their carers and gets lost. Further, the ability to process thoughts and deal with visual data whilst walking or when lost is very low for patients with dementia and an automated solution is the most effective form of surveillance and searching for someone lost but with a wearable communication device.

Before providing a summary of the research findings for the CPR Guardian wearable solution, the report will return to address the process and costs of operationalizing a search for a missing person.

The Costs

The cost of a missing person in the UK can vary greatly depending on the circumstances of the case, such as the length of time the person has been missing, the location of the search, and the resources required to locate the missing person. Factors such as the cost of search and rescue operations, the cost of investigations and police work, and the cost of providing support to the family and friends of the missing person can all contribute to the overall cost. additionally, the cost of a missing person can also include indirect costs such as lost productivity and decreased economic activity. it is difficult to estimate a specific cost for a missing person case without more information about the specific circumstances.

The review of the process, conducted by the Swansea University team, indicates that the following costs would be incurred to the police force budget to find a missing person in the 24 hours that the Alzheimer’s Society propose is typical for 90% of missing persons attributable to dementia and reduced cognitive abilities.

Per case reviewed and investigated for 1 day (Alzheimer’s Society state 90% of all missing persons cases are found in one day)

Activity	Person(s)	Average Salary	Time	Cost	Notes
Risk Assessment	3 Officers	£32,000 per annum or £11.90/hour	30 minutes x 2 Officers	£11.90
	1 Sergeant	£43,000 per annum or £15.99/hour	30 minutes x 1 sergeant	£7.99
Enquiries	2 Officers	£11.90/hour	5 hours x 2 Officers	£119.00	2 shifts as night time visits for enquiries are untypical.
	Travel expenses		40 miles travelled per shift (80 Miles)	£36.00	£0.45 HMRC expense rate.
Shift handovers	12 officers and 1 sergeant	12 x £11.90 + 1 x £15.99 per hour	Cost of the team (x 3 shifts)	Officers (£2.28) + Sergeant (£0.26) = £2.54 times 3 shifts £7.62	5 minute team review at beginning of shift only
				£174.89

The daily Cost Per Missing Persons Case, for the simplest of cases, is therefore £174.89. From the research, this is a highly understated case cost because others may be involved beyond the direct team. If a dog handler is used then this would require an additional £5.95 per hour as well as additional motor vehicle expenses. For the calculations, the research team used mid point salaries (service and grade) and the annual salaries of each grade of officer can be reviewed in the appendices. If a police helicopter and crew are to be launched then this would incur another £1700 per hour (or a real search time of 40 minutes given travel to and from the sites where the person is hypothesized to have travelled. With these additions the £174.89 rises to £1880.84 for the slightly escalated and higher triaged case.

To recalculate the equation to the 99% of missing persons with dementia being found (in various states of distress) in one week then:

Number of Days Missing	Costs to the Police Force
2	£439.78 plus senior management daily review
3	£524.67 plus senior management daily review
4	£699.60 plus senior management daily review - This is the likely point of escalation and specialist resources are engaged.
5	£874.45 plus senior management daily review
6	£1049.34 plus senior management daily review
7	£1224.23 plus senior management daily review

There are also hidden costs where senior police force staff are involved in daily meetings and reviews at the beginning of each working day. These staff have higher salaries and these meetings involve significant numbers of service staff even for a brief period of time per case review.

It must also be noted that the costs and time involved with searching for a missing person with cognitive impairment is one side of a bigger cost to the service. The additional costs the opportunity lost (in time) when the force could be conducting another activity with the officers involved.

In addition, there is also a skew to missing persons generally and also when cognitive impairment is concerned. In this manner, certain individuals will feature regularly due to the nature of their conditions and the ability to leave their normal living environment.

The Comparison

Having established the minimum cost per episode for the police force of £174.89 and 24 hours (max) of missing person exposure, the research team then assessed the use of the CPR Guardian wearable watch technology.

The Properties of the Watch

Watch and Service Capability	Benefits for the Police Service
Global Positioning System	Avoidance of use of Police Service as monitoring Centre and alerts to nominated carers are tracked 24 hours a day (Cost avoidance).
Use of Strongest Signal Carrier	Signal strength remains high and reporting accurate location. Triage process reduced and officer can be assigned to secure the custody of the person in minimal time. Closest officer response. Benefit: Missing person is detained within 15 minutes (Cost avoidance)
Watch monitoring features and coordinating CPR Guardian Monitoring Centre	The missing person has vital signs being remotely tracked to prevent deterioration and to liaise with emergency services (including paramedics), GPS tracking allows swift access and ability to report whether the patient has fallen (altimeter monitoring) and other vital signs.
Monitoring Centre direct phone access	The Monitoring Centre (once activated by a carer or via the sophisticated monitoring processes and algorithms) can call the patient directly and assure them help is on its way (assurance), talk to passers by and process information quickly. The phone mechanism also allows the Monitoring Centre to liaise with the police or paramedics at the scene.

The Review

The comparison of the current method of dealing with missing persons (a vital role for the police in all cases (human trafficking, abductions, etc.). is costly and can rapidly escalate after a period of time has elapsed and the police force assumes responsibility to search and find the person with dementia.

The person with dementia undergoes significant trauma and stress as a result of losing their ability to navigate safely to their intended destination and lack the ability to process their surroundings, navigate and remain steady on their feet. They are at significant risk and highly likely to use paramedic services if found by a member of the public in an apparent ‘dazed or confused’ state.

The carer (individuals or Organisational) undergo significant stress and potential litigation for those who have a duty of care to the person with dementia.

The quicker the ability to detect the location of a person with dementia is preferable and the research shows:

Scenario	Response Time
Monitoring Centre alert is triggered by the CPR guardian monitoring algorithms	Less than 1 minute.
Monitoring Centre response to Panic Button activation (by wearer or passer by)	Less than 1 minute
Monitoring team is alerted by carer, family or police	Less than 1 minute
Server reliability (computer infrastructure)	99.999%
Battery life of the watch (from full charge until depleted) following person going missing	Xxx Hours
Time between reported GPS location	Less than 1 minute
Geo Fence setting	The user or carer can establish a geo fence that alerts the Monitoring Centre which triggers an alert is the person leaves a set location and perimeter.

The most obvious application of CPR Guardian for the police and local authorities (and care providers) is to use the wearable watch for persons with a proven regularity of getting lost. The payback for the police force (if they had bought the watch and service for one year) is just one episode of one day. For an individual who features regularly as a missing persons then such a level of control would release significant hours and time back to front line staff (avoidance of the costs of investigative enquiries by officers).

The UK economy also gains from such a deployment because time is lost from sons and daughters of the person with dementia (in terms of lost working time as they join the coordinated search for loved parents). Such losses to national productivity are high.

For local councils who operate care homes from which the person with dementia may have left to then enter a state of loss, confusion and exposure to danger, there are also gains in terms of securing their care home residents in a short time whilst knowing the condition of the person as a member of staff is sent to collect them.

The paramedic services also gain from such a device as unnecessary conveyance or use of paramedic time is reduced when the person is found and communicates with the monitoring Centre.

The gains offered by the wearable technology are significant and align well with the use of digital processes and technologies by many stakeholders including the modern police force. The efficacy of the watch and the case studies of users that were reviewed by the research team show significant benefits in the confidence of monitoring loved ones or residents as well as significant cost savings for individuals or organisations that have engaged with the technology. The wearable nature of the product also offers significant benefits over the potential offered by a standard mobile phone connected to just one contract carrier.

The Verdict and Future Potential

The CPR Guardian watch is a viable product and solution to track, trace and secure the safety of vulnerable individuals. The Dementia UK report states that 1 million people have the condition in the UK (2021 figures) and this is set to rise to a (worst case scenario) of 2 million by 2051. Under such conditions the volume of missing persons is likely to grow for all police services. Rural police services will face pressures to locate individuals in terrain that is unconducive to finding a person easily and the CPR Guardian technology offers a significant solution to such demand on front line officer time. For police forces with significant urban and city-settings the solution has the ability to secure individuals quickly.

As digital services unite organisations (and core processes) in the private and public sectors as well as uniting health and care providers, of all forms, the wearable technology is a means of maintaining a virtual ward for organisations and families. The setting geo fences (setting boundaries based on the GPS) compresses time between detection and returning the person to safe care. In summary, the digital developments associated with this wearable technology are comprehensive, the reliability of the hardware and software offers significant opportunities for safeguarding, and cost avoidance for organisations at a contract cost that most UK citizens/organisations can afford as a monthly financial commitment.

This paper has shown the significant cost advantages of using the CPR Guardian technology in the context of the police service and what benefits can be derived from engaging with new technology to support a modern police force.

Appendices

Appendix 1: Police Force Salaries used in the cost calculations (2022 UK Government figures).

Police Constable: starting salary of around £24,177 and rising to £40,128 after 7 years' service.

Sergeant: starting salary of around £40,128 and rising to £46,569 after 7 years' service.

Inspector: starting salary of around £46,569 and rising to £52,446 after 7 years' service.

Chief Inspector: starting salary of around £52,446 and rising to £56,905 after 7 years' service.

Superintendent: starting salary of around £56,905 and rising to £69,929 after 7 years' service.

Assistant Chief Constable: starting salary of around £69,929 and rising to £96,966 after 7 years' service.

Deputy Chief Constable: starting salary of around £96,966 and rising to £126,966 after 7 years' service.

Chief Constable: starting salary of around £126,966

About the authors

Professor Nick Rich is a world-renowned expert in High Performance (quality) and Highly Reliable Organizational (safety) design. Nick has written over 100 publications, he is an adviser to multiple governments, he has written 10 books, and he holds the Toyota Motor Corporation Fellowship of Japan. He was the Chief Industrial Engineer at the Royal Mint for the production of the Olympic and Paralympic Games medals (London 2012). He is an adviser to a number of Governments and Royal families.