By Julie Williamson, 4/01/2011, with permission from McKnight’s Long-Term Care News & Assisted Living
Much of Julie’s advice for assisted living centers can also help people with neurological problems stay longer in the familiar surroundings of their homes, so I thank her for letting me republish it here.
As more seniors enter assisted living with mild to moderate dementia, operators are faced with a somewhat daunting dilemma: how they can keep residents who tend to wander safe, without stripping them of their independence and freedom to roam the community they call home.
While managing wander-prone residents can indeed prove challenging, increasingly reliable technologies are helping staff to keep tabs on the whereabouts of at-risk residents. These systems help prevent elopement and other potentially dangerous wandering incidents that can put residents’ health and providers’ bottom lines at risk.
Enhanced system flexibility, user-friendly functionality and discreet alerts are at the heart of today’s leading wander management solutions, sources say.
“Most of these systems can be set to not be alerted unless a [resident] goes in restricted areas. These security solutions keep track of [resident] wandering, but also give residents their independence,” explains Alan Bingham, senior marketing manager, AliMed Inc., Dedham, MA.
In assisted living—where cognitive function can vary widely from one resident to the next— there’s a strong, collective desire by the senior population to reside in a setting that fosters autonomy. Operators, understandably, are seeking wander management solutions that afford a greater level of flexibility and customization.
Such technologies could make the difference between allowing a high-risk wanderer to stay in assisted living, as opposed to transferring such a resident to a more secure skilled nursing facility.
“The risks and personal needs associated with effectively managing the wide variety of elopement or wandering situations demand a range of affordable and customizable solutions, even for those that are not an explicit wander risk per se,” notes Kelly Besecker, vice president of sales and marketing, AFrame Digital Inc., Reston, VA.
Perhaps an administrator wants to know if a particular resident goes outside when the weather is below freezing, so they can be sure they are not out too long, she explains, or maybe there’s a need to monitor a frail, yet still independent resident who hasn’t returned home by an expected time.
“The ability to personalize options allows caregivers to have predictive insights to enable proactive care for a given resident’s specific needs,” Besecker notes.
Today’s wander management technologies are also more affordable—and increasingly discreet.
“Dignity and privacy are major concerns. The system should be designed in line with the high-end designs of assisted living communities, and should support the quiet environment trend,” says Jon Ross, general manager, HomeFree Systems, Milwaukee.
Increasingly, solutions that allow staff to set up “hot zones” are becoming more popular, according to Besecker, because staff can redirect residents who enter a predetermined off-limits zone. Exit alerts and off-campus alerts also can be set on or off for an individual or group of residents.
“The system also can trigger door locks and other mechanisms to reduce the risk of elopement,” Besecker says, adding that silent alerts delivered in real time to staff pagers, smart phones or any other voice or data device already in use in the facility can help ensure immediate action by staff, without the need for disruptive, dignity-robbing alarms.
Preventing dangerous wandering and elopement is indeed critical, but more operators are opting for technology that can offer a second line of defense. Cellular-based tracking solutions, which operate via residents who wear a watch-like device that can be precisely located virtually anywhere within an existing cellular network, is one example of this added layer of protection.
“This cellular-based system can work indoors or outdoors, and can locate people quickly and precisely, even in buildings or places that would typically interfere with GPS locators,” says Jim Nalley, chief executive officer of EmFinders, Frisco, TX. The company’s EmSeeQ technology, developed in collaboration with law enforcement, is activated by a caregiver and utilizes the 9-1-1 emergency system.
Radio frequency identification (RFID) and global position systems (GPS) also are gaining momentum in the wander management segment.
“Extending the personal emergency response systems, there are systems on the market that can provide GPS tracking to help find individuals who end up wandering from a facility,” says Brian Jones, director, Aware Home Research Initiative, and senior research engineer for Georgia Tech’s Interactive Media Technology Center in Atlanta. “These technologies are more reliable than those we have seen in the past.”
Resident compliance is another critical factor. As sources explain, residents might try to tamper with or dismantle a wander management system, or they might attempt to remove the wristbands that track their location.
“Being able to know when the device is being worn or not is essential for any resident we want to feel secure,” says Besecker.
Because of the challenges associated with resident compliance, some vendors are now opting for GPS or RFID tags that can be easily and unobtrusively attached to a resident. The GPS or RFID device then alerts and guides the caregiver in the direction of the resident.
“Things like a departure alert placed above a doorway keeps track of [residents] and alerts a caregiver when there is unwanted wandering. Simple systems, such as mats that can be placed at doorways, also monitor resident wandering and prevent elopement,” Bingham says.
Even the best wander management solution won’t be worth its salt if caregivers fail to use it properly. For starters, batteries must be charged or replaced regularly to ensure that resident-worn bracelets or pendants are working as intended.
“Batteries are always an issue with any system that is truly wireless, and especially for the wearable components,” confirmed Jones, adding that active location monitoring and GPS tracking will drain a battery much faster than a simple button press that’s activated by the resident on a PERS device.
Vendors are doing their part to keep systems working properly by using extended-use batteries and building in alerts for low battery power. Still, many operators are adding their own safeguards by incorporating battery checks into their monthly safety checklists to prevent any devices from slipping through the cracks.
Today’s wander management solutions also are being designed with expandability in mind. More than ever, vendors are creating systems that support a range of applications, including remote health monitoring and fall prevention and detection.
“By being able to add this capability to their resident monitoring solution, assisted living operators are able to keep residents in their community longer than they did in the past,” reasoned Ross.
Innovations in resident health monitoring solutions, along with passive or “sensor” technologies that can be used in resident rooms to alert staff to potential problems or resident changes, are further allowing facilities to enhance resident safety and response. According to Besecker, these passive monitoring solutions are more effective when used in conjunction with an active solution—with positive identification and authentication of the person wearing the monitor.
“Passive monitors lose their effectiveness when there are multiple people in the environment as assumptions will need to be made about motion, door sensor indications, common activities and so on,” she says. “These types of issues can lead to inaccuracy in reporting status and [potentially inaccurate] conclusions about the data.”
Having systems that can be personalized to the evolving needs of each resident also is important for assisted living operators.
One example is when couples move into assisted living together, but present very different care needs and monitoring requirements. A wife, for example, may be more frail and at risk of falls, but is still the main caregiver for her husband, who is cognitively impaired and at greater risk for dangerous wandering or elopement. Both residents may be outfitted with a monitor, but for different reasons. And in the case of the resident with cognitive impairment, additional safeguards may be used, such as ZigBee locks on exit doors with delayed opening.
“With the ZigBee locks on the doors, now when the wife takes a nap, if the husband approaches the door to try to exit the home, the door would automatically lock and then the system would send an alert to the wife’s phone,” says Besecker of the AFrame system. “The watch also protects the wife because if she were to fall, an alert would be automatically generated and [sent to caregivers].”
Staff driven success
Of course, dedicated, well-trained staff members are what really drives the success of any resident safety technology.
At Baltimore’s Levindale Hebrew Geriatric Center and Hospital, all at-risk residents are outfitted with a departure alert bracelet, but staff don’t rely solely on the technology to prevent incidents. An alphabetized binder with photos, names and descriptions of all high-risk wandering residents is readily available at the 24-hour security desk to serve as a reliable visual. The facility also uses employee photos to conduct elopement drills and help ensure that all staff members understand their role in the event of an incident.
“If an elopement occurs, the team gathers immediately and begins searching the unit, and there’s also a larger gathering of employees that searches other designated areas,” says Amy Boulware, RN, Levindale’s Hall 2 clinical leader. For further patient protection, staff visually check all resident beds nightly. Facility staff, along with the wander management bracelets, help ensure they are functioning properly. Battery expiration dates are also monitored routinely.
Educating visitors and family members about elopement and wandering risks is also critical.
“Some people just like to wander and that isn’t necessarily a bad thing. We allow our residents to be who they are and if wandering in a safe way is what they want to do, we don’t try and stop it,” adds Boulware.
“But it’s important to really try to understand each resident and determine why they might be wandering. Sometimes, we just need to redirect them, as appropriate. But always it’s about providing [resident]-centered care that puts their needs first,” Boulware says.
See also: Don’t Just Blame Dementia