5 common mistakes to avoid when choosing a nurse call system

Introduction

Choosing a nurse call system for a care home is not a classic equipment purchase. It is a structuring decision that commits your facility for ten to fifteen years, impacts the daily life of your care teams, conditions the traceability of your interventions and represents a significant budget line across the entire life cycle.

Yet the same pitfalls come up at each renewal cycle. Tender briefs focus too often on the initial purchase price, underestimate future costs, ignore emerging regulatory constraints or overlook the human dimension of deployment. The result: technically sound but under-used installations, maintenance contracts that balloon after three or four years, or extensions that prove impossible during a building expansion.

This article reviews the five most frequently observed mistakes in the sector, and more importantly the concrete good practices to avoid them. The aim is not to draw up an indictment against a category of suppliers, but to give you a clear analytical grid, usable from your next tender, to secure a long-term investment.

Mistake 1 — Looking only at purchase price, not 10-year TCO

The analysis

Quote comparisons are almost always made on acquisition price: number of buttons, server price, installation cost. This approach masks the economic reality of a nurse call system, the majority of whose cost materialises after go-live.

Over a ten-year horizon, the initial purchase price frequently represents less than half of total cost of ownership (TCO). The most often underestimated items are:

• Annual licences (per bed, per station, per module), which can double or triple the cumulative bill.
• Software updates, sometimes invoiced separately or conditional on a premium maintenance contract.
• Battery replacement for buttons and carer terminals (professional smartphones or DECT handsets), whose lifespan is limited.
• Forced hardware migrations (end of support for a button model, radio standard change).
• Technical interventions billed per unit outside the contract.
• Additional training on each major update.

Two offers within 5 % of each other at purchase can show a 40 to 60 % gap over ten years. This difference generally only becomes visible after 36 to 48 months, when it is too late to renegotiate without changing the whole system.

How to avoid it

How to avoid it

Require from each supplier a detailed 10-year TCO quote, item by item, and compare offers on this basis rather than on acquisition price. Ask in writing about the annual reindexation policy on licences and maintenance contracts.

TCO checklist to request from every supplier

• Detailed acquisition price (hardware, software, installation, initial configuration).
• Annual licence cost (per bed, per station, per additional module).
• Annual indexation formula applied to licences and maintenance.
• Annual hardware maintenance cost (preventive and corrective).
• Cost of major and minor software updates.
• Estimated lifespan of buttons, carer terminals (pro smartphones or DECT), base stations; unit replacement cost.
• Expected cost of hardware migrations over 10 years.
• Hourly rate for out-of-contract interventions.
• Cost of recurring training (new carers, refresher, new features).
• Potential penalties for early exit or scope reduction.

Mistake 2 — Underestimating proprietary hardware lock-in

The analysis

Most historical nurse call systems rely on proprietary radio protocols, buttons and servers. Once installed, your facility can no longer freely choose its equipment: each additional button, each carer terminal (smartphone or DECT), each base station must be bought from the original supplier, on the commercial terms it sets.

This hardware lock-in has several medium-term consequences:

• Reduced bargaining power during extensions or partial renewals.
• Total dependence on the manufacturer’s product roadmap (if a model is discontinued, you follow).
• Inability to mix brands to benefit from interesting innovations (wandering prevention, fall sensors, etc.).
• Prohibitive exit cost: changing system requires replacing the entire hardware fleet, not just the software.
• Risk in case of supplier failure (acquisition, change of strategy, cessation of activity).

Lock-in is not necessarily ill-intentioned, but it constitutes a structural imbalance in the commercial relationship that deepens year after year.

How to avoid it

How to avoid it

Favour systems with open architecture, capable of working with several generations and several brands of peripherals. Ask explicitly about the supplier’s hardware interoperability policy and which standard protocols are supported.

Questions to ask every supplier

• Are the buttons and carer terminals (professional smartphones or DECT handsets) used compatible with third-party brands?
• Which radio and network protocols are supported (standard vs proprietary)?
• Does the system accept the later addition of sensors from other manufacturers (wandering prevention, fall detection, environmental sensors)?
• What is the minimum commitment duration and what are the exit conditions?
• If the supplier ceases activity, does the facility have access to settings and data?
• Do software updates make still-functional hardware obsolete?
• Is there accessible technical documentation describing the architecture and possible integrations?
• Can the system integrate with the business software already in place (resident record, carer scheduling)?

Mistake 3 — Overlooking GDPR compliance and traceability

The analysis

A nurse call system by definition handles sensitive personal data: calls timestamped by resident, carer response times, location (in the case of wandering prevention), sometimes contextual clinical elements. As such, it falls within the scope of GDPR and Belgian health data protection legislation.

Three points are regularly overlooked in tender briefs:

1. Data retention period is not documented, or is not configurable. Some installations keep call logs for years without justification, others purge them too quickly to allow quality analysis.
2. Access traceability is not guaranteed: who consulted what, and when? In the event of an inspection or complaint, the facility must be able to document access to resident data.
3. Data location (local server? Cloud? Which country?) is sometimes unclear, which can cause problems during an audit or in case of subprocessing outside the EU.

In addition, reliable historical archiving of calls is a major asset for quality steering: average response times, activity peaks, detection of abnormal situations. A system that does not allow exporting or analysing this data deprives the facility of an important steering lever.

How to avoid it

How to avoid it

Require formal GDPR documentation: processing register, configurable retention period, access log, processor agreement compliant with Article 28 of GDPR. Verify that the supplier is able to produce these elements without delay.

GDPR and traceability checkpoints

• Does the supplier provide a GDPR-compliant data processing agreement (DPA)?
• Is the retention period of call data configurable by the facility?
• Is the data hosted in the European Union? On what infrastructure?
• Is there an access log for data (who, what, when)?
• Are backups encrypted and where are they stored?
• Which rights of data subjects are operationalised (access, erasure, rectification)?
• Are data exports possible in a reusable standard format?
• Is there a continuity plan in case of incident (data loss, outage, cyberattack)?
• Has the supplier already documented a data protection impact assessment (DPIA)?
• Are security updates deployed automatically, and within what delay?

Mistake 4 — Not anticipating the facility’s evolution

The analysis

A care home is not a static entity. Over ten years, most facilities experience at least one structural evolution: expansion, creation of a unit adapted for disoriented residents, merger with another site, addition of a short stay, addition of complementary services. Each of these evolutions has a direct impact on the call system.

The frequently underestimated constraints are:

• Crossing a capacity threshold (for example from 60 to 120 beds), which may require a licence change or even a server change.
• Adding a wing dedicated to residents with dementia, which implies wandering prevention coverage and differentiated alarm management.
• Changing care team organisation (new shifts, new hours, new responsibilities), which requires reconfiguring call routing rules.
• Cohabitation of several buildings on the same site or on distant sites, with the centralised supervision questions this raises.
• Future integration of connected objects (fall sensors, presence detectors, non-intrusive security cameras).

A system designed only for the current configuration can become a brake as soon as an evolution project materialises. It is then tempting to postpone these projects or, conversely, to commit to a full system replacement prematurely.

How to avoid it

How to avoid it

Project your facility ten years ahead from the tender brief phase. List all conceivable evolution scenarios, even unlikely ones, and ask each supplier to describe their response to each, pricing included.

Typical case to test

Imagine the following scenario and ask each supplier how they would handle it:

• Year 1: installation on 60 beds spread over two floors.
• Year 3: addition of a wandering prevention module for 15 residents with dementia.
• Year 5: construction of a new wing bringing the facility to 120 beds.
• Year 7: integration with the business software to feed calls into the resident record.
• Year 9: opening of a second site 40 km away, supervision desired from the main site.

For each stage, ask:

• What additional hardware will be needed?
• What impact on licence and maintenance contract?
• What implementation time?
• What cost estimate, indexation formula included?
• Will the system natively support the addition, or is a redesign needed?

A supplier unable to answer this exercise clearly is probably a supplier who will improvise when the time comes, at your expense.

Mistake 5 — Underinvesting in carer training

The analysis

The finest nurse call system in the world remains an empty shell if carers do not use it correctly. Yet training is systematically the most compressed budget line in a deployment: half a day initially, a PDF manual, and the tacit certainty that “the teams will adapt.”

The field reality is more nuanced:

• Turnover in the sector means that a significant portion of initially trained carers will have left the facility within two years.
• New arrivals rarely receive structured training on the call system, and learn by imitation, sometimes with colleagues’ bad practices.
• Updates introduce new features that remain unused because they have not been presented.
• Exceptional situations (emergency management, call hand-off, degraded mode) are only addressed theoretically.
• Night teams, often smaller, receive less training than day teams while using the system in more critical conditions.

The cost of an under-used system is invisible but real: unused steering features, time wasted on inefficient manipulations, team frustration, loss of buy-in.

How to avoid it

How to avoid it

Budget training as a recurring investment, not a one-off cost. Integrate it into the induction path of each new carer and plan refresher sessions at each major update.

Standard training plan to include

• Full initial training of all teams (day, night, weekend, stand-ins) before go-live.
• Concise operational documentation posted in care stations (not only a PDF manual).
• System referent identified in each team, trained in depth, capable of answering common questions.
• Induction module specific to each new carer during their probation period.
• Quarterly refresher sessions of 30 to 60 minutes, targeted at observed real uses.
• Dedicated session for each major update of the system.
• Annual review of practices with the management team and care referent.
• Usage metrics: feature take-up rate, response times, calls handled directly from carer smartphones or DECT rather than via the central console.
• Supplier support available for ad hoc questions, with contractualised response time.

Final checklist before decision

Before signing, validate that each of the following points has been explicitly addressed in your selection process:

1. You have a comparable 10-year TCO quote for each shortlisted supplier.
2. You know the annual indexation formulas for licences and maintenance contracts.
3. You have checked the degree of hardware openness of the system (interoperability, standards, third-party brands).
4. You have obtained the exit conditions and data recovery arrangements at the end of the contract.
5. You have a GDPR DPA compliant with Article 28 and know the data location.
6. You have validated the parameters for retention period and access traceability capability.
7. You have projected your facility ten years ahead and tested the evolution scenarios with each supplier.
8. You have budgeted initial and ongoing training for the care teams.
9. You have verified the supplier’s financial and operational solidity (seniority, references, retention rate).
10. You have at least two references from facilities similar to yours, with the possibility of contacting them directly.
11. You have validated the frequency of software updates and their deployment mode.
12. You have a single point of contact identified at the supplier for the contract duration.

This checklist does not exhaust every possible topic, but it covers the most frequent blind spots. If a supplier stumbles on several of these points, it is a signal that they will probably provide the same vague answers in future difficulties.

Healthcall’s position

Healthcall is a SaaS nurse call solution designed for Belgian care homes. It has been operated since 2017, eight years of production experience, and equips around twenty facilities today (21) from 30 to 150 beds, representing approximately 1,250 residents. Across this period, we record a single client departure.

On the five mistakes described in this article, here is our factual positioning:

• TCO: transparent pricing from 50 € excl. VAT per button, no contractual surprises over time.
• Lock-in: open architecture, no proprietary hardware lock, integration possible with several peripheral brands.
• GDPR: native compliance, triple database replication, controlled hosting, integrated logging.
• Scalability: the premium hosting platform is designed to follow facility evolutions, with 4 updates per year included.
• Training: documentation and support included, no hidden recurring billing.

We are a Belgian company based in Frasnes-lez-Anvaing, self-funded, with no dependence on an outside investor likely to impose a short-term change of strategy.

Going further

If you are preparing a tender or renewal of your nurse call system, we can provide you with a blank 10-year TCO comparison grid, usable with any supplier, as well as a list of references from equipped facilities with which you can speak directly.

Contact us to arrange a no-commitment conversation: we will share our eight years of sector experience, even if you do not ultimately choose Healthcall.