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New technology allows residents to roam freely but also helps to keep them safe and within proper boundaries

In this more enlightened age of long-term care, controlling wanderlust among residents has become a delicate balancing act between respecting residents' freedom of mobility and imposing measures that protect their safety.

The archaic methods of restraint, sedation and seclusion have long since been replaced with a more tolerant philosophy, innovative "wander-friendly" architectural design and sophisticated electronic monitoring devices that give roaming residents more range and latitude in their endeavors.

How much freedom a resident is allowed often depends on facility management's philosophy, and no two management teams see things exactly the same way. The trick, as always, remains keeping wanderers within designated areas so they don't stray into trouble, or elope into danger spots.

Classifying a wanderer

Allowing residents the freedom to roam and explore (within limits) is "a phenomenal trend," acknowledges Diane Hosson, vice president of marketing for Ottawa, Ontario-based Xmark. In fact, she credits the provider community with originating the positive philosophical changes that have created wander-friendly paths and gardens.

"It is the facility operators who have developed new terminology, such as 'homelike environment' and 'residents' instead of 'patients,' she said. "And in their dedication to improving the quality of life for their residents, they have inspired the manufacturing community to build products along those lines so that they accommodate different types of residents."

The Xmark patient monitoring system allows facility operators to use discretion in granting the most lucid residents the widest access possible while exerting tighter controls over those who are in later stages of Alzheimer's disease or dementia.

"It's categorization on an individual basis," Hosson said. "The system can be programmed so that one resident can roam freely while another may be unit-restricted. The system also can be programmed on the basis of time, so that Mrs. Smith is free to meet with friends during the day but cannot leave the floor at night."
Today's monitoring systems not only should be respectful of residents' privacy and freedom, they also should respect the staff's routines, Hosson said.

"Caregivers aren't office people waiting around the desk for a call they're out interacting with residents," she said. "Our system doesn't chain them to a desk – it works with a wearable wireless device so that if an alert is issued, the person closest to the area can deal with it without changing workflow."

The aging-in-place concept also is influencing how electronic security system vendors design their products. Hosson explains: "We're seeing more couples coming over from assisted living to skilled nursing facilities together. The husband might be talkative with no problems but the wife may have some memory issues. We don't want to change their lifestyles, so we can work out a program where the wife has the security she needs without compromising her husband. Her bracelet can allow her to travel with him, but sounds an alarm if she is by herself."

Maintaining dignity

The movement toward making long-term care facilities less institutional and more homelike is part of an attitude that strives to preserve the residents' pride and dignity. Security system vendors recognize and appreciate that approach and have tried to incorporate it into their product lines, says Lorna Schaefer, national sales manager for long-term care at Brookfield, WI-based RF Technologies.

"Aesthetics are an important part of changing the institutional look and feel of a facility," she says. "So when it comes to our products, we want to make them as unobtrusive and neutral as possible, so that they blend into the nursing home environment."

The latest example of this outlook is the RF Technologies' CodeWatch, a transmitter that resembles a wristwatch. Small and lightweight, the device gives residents the familiar feel of wearing a watch so it improves compliance, company officials say. The waterproof transmitter is designed to be suitable for wearing in the bathtub or shower.

When a resident wearing the CodeWatch approaches a monitored door, the device sends a signal to an antenna, sounding an alarm or locking that door. Facilities can then choose to send alert information to a central location identifying the resident and the monitored exit.

Despite the necessary elements of resident containment, the ultimate goal is safety and protection while offering each resident the maximum amount of freedom possible, Schaefer says.

"My philosophy is to let each resident have as much roaming space as possible and give them most the protection possible, as well," she says. "We want to help each resident by giving them the dignity they deserve while also looking out for their safety."

Having a good anti-wandering system in place is important to keeping your residents safe from the risk of elopement from the facility. But the first line of defense against possible elopements is to have good preventative measures in place," says Danielle Riebe, associate product manager for Dassel, MN-based Crest Healthcare Supply.

"By helping reduce environmental 'triggers' and promoting good practices through well-informed staff and visitors, you can create a therapeutic atmosphere for residents to move around in safely," she says.

Industry estimates peg those likely to wander at approximately 10% of a facility's population. Restlessness, boredom and agitation caused by dementia or Alzheimer's are cited as the most common reasons behind a resident's urge to wander. And while some facilities have incorporated architectural elements that accommodate wandering, Riebe says there are a number of preventative measures facility operators can use to control wandering.

Activities important

"Ensure that your residents have lots of activities to engage in to help keep them active and stimulate them in healthy ways," she says. "Be sure to include plenty of activities that allow residents to spend structured time outdoors in a safe environment. This can be especially important during the warm weather months when many residents long to be outdoors."

Preventive measures can help a facility reduce its number of elopement attempts, but attempts will occur nonetheless, so it is essential that operators augment policy with technology. Electronic wander alert systems that monitor resident movements and notify staff are becoming more commonplace in facilities.

Most electronic security systems use a radio frequency-based tracking device worn on the resident's wrist or ankle. Strategically placed relays serve as boundaries around exit doors and other areas such as swimming pools. If a boundary is breached, staff members are immediately notified on their personal digital assistant, pager or wireless phone.

Meeting Mobility issues

The rise in seniors housing facilities, such as independent living and assisted living centers, has resulted in nursing home residents being older, more frail and less physically able to wander, Schaefer notes. Still, facilities should take precautions with potential wanderers even if they have mobility limitations, which is why RF Technologies offers bed and wheelchair alarms that alert attendants.

Although most elopements can be prevented with electronic surveillance, Riebe advises that facilities have an emergency procedure in place to help guide staff in case an elopement does occur.

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Tracking residents by satellite

An international study will examine how global positioning systems can help researchers learn about resident wandering patterns.

Conducted jointly by the Hebrew University of Jerusalem and University of Heidelberg in Germany, the five-year, $1.9 million project is titled "Use of Advanced Tracking Technologies for Analysis of Mobility in Alzheimer's Disease and Related Cognitive Disorders."

Tracking and studying the wandering habits of long-term care residents with Alzheimer's and dementia may provide researchers with clues on how to better diagnose the disease and GPS' impact on residents' quality of life.

Noam Shoval, professor of geography at the Hebrew University of Jerusalem and one
of the principal investigators for the project, said using HomeFree's GPS system saved the team the expense and effort of creating its own system for the project.

HomeFree President Guy Lerner said the company was pleased to participate in the study, which is funded by the German Federal Ministry for Education and Research
and the German Aerospace Center.

"We will extend the researchers our support and technology expertise," Lerner said.
"We look forward to receiving operational feedback that is bound to enable us to further tune our systems to the eldercare monitoring markets needs."
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