Alarming headline about safety gives incomplete picture

James M. Berklan
James M. Berklan

Curse the headline writers, for they sometimes don't do stories justice. The nursing home profession knows this as well as anyone.

That might sound like an odd pronouncement from a journalist. A cannibalistic cut even. But it comes from someone who has written more than his fair share of headlines over the decades. Take that for what you will.

Actually, it's an overt acknowledgement that headline writers have too little space to try to say too much. And when they don't get it right, or even just part right, it can inflict serious damage.

Just ask the suppliers of bed and chair alarms. They must have felt a javelin-sized needle in their side Friday when the Boston Globe ran an article titled, “Nursing homes find bed, chair alarms do more harm than good.”

Get rid of the bed- and chair-alarm makers! Put them out of business! The profession has spoken and it doesn't want these hucksters around any longer!

That's a reasonable interpretation upon reading the headline. But as so often happens, the headline tells only part of the story. To be fair, that's because the story tells only part of the story, as I'm sure any number of alarm makers would love to point out.

The article speaks of respected Northeast provider Hebrew SeniorLife and how it “virtually eliminated” alarms at two of its rehab and long-term care facilities. The result was hundreds of devices not bought or put into place — and better resident functionality as a result.

A research committee came up with a “purposeful rounding” routine that forms the backbone of the Pioneer Network-backed initiative. A 2013 pilot involving 30 patients employed more focused attention from caregivers, and led to more independence for at least some of the study subjects.

A key focal point is Hebrew Rehab's fall rates. Initially, they declined, but they have fluctuated since, the article notes, due in part to the effects of advancing dementia on residents.

It's interesting that so many conversations about institutional caregiving circle back to the fact that skilled nursing is a needs-based industry.

It's an issue vendors likely would have seized upon, if only given the chance in the Globe article. But they weren't, and an intriguing, if only partially serviceable headline, slammed the door on them.

Some nursing homes have found that some bed and chair alarms aren't needed,” would be a more responsible, if Pollyannaish, way to have labeled the article. After all, the piece discusses only two facilities that have put the new program into place, and fall rates have varied after an initial good bounce.

Let me stop now to emphasize that the discontinuation of unnecessary alarms in a good thing, just as a cutback in unnecessary antipsychotics is. However, to imply that all bed and chair alarms, or all uses of antipsychotics, are bad or unnecessary is flat out wrong.

The initiative described in the article was applied to only a targeted resident population. Some residents are ripe for becoming more independent. Test it fully across the board, and one suspects some different results would pop up.

By the same token, only a certain type of caregiver is going to make this approach work well — namely a diligent, organized, skillful nurse who can perform rounds more thoroughly than the industry standard now typically affords.

It's also a good time to point out that alarms are merely tools. If misused or not attended to, there could be problems — just like with cruise control on your car or any variety of machinery. Use them properly — or else.

McKnight's has written about bed- and chair alarms' use for years. I can't think of a lengthy article on the topic that hasn't included the admonition — typically vendor noted — that resident safety systems work only as well as those who use them. 

This will never change. Yet it bears keeping in mind that even the best workers can benefit from using up-to-date tools and technology.

If that means quieter or otherwise improved bed- and chair-alarms, so be it. But to see the world without them entirely? Curse the thought.

James M. Berklan is McKnight's Editor. Follow him @JimBerklan.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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