Information Technology: Wireless? Why not

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Wireless nurse-call systems are creeping into nursing homes more often — regardless of what regulations say or imply. Nobody's ready to call it a tidal wave yet. But there are signs of an undercurrent starting to form, and a type of wave is involved. Wireless technology is beginning to appear more often in nurse- and emergency-call systems in skilled nursing facilities around the country. Until recently, the thought of it was virtually unheard of. For a variety of reasons, the technology had cracked into the less-regulated, more entrepreneurial assisted- and independent-living segments earlier but not skilled nursing.

That is starting to change, though there is no simple blueprint for how to perform mass installations. Wireless is still a non-standard route; compounding the challenge is  the fact that most state and local safety codes stack the deck in favor of hard-wired systems.
So, providers – short on cash, impeded by existing rules and slow to embrace change anyway – have not swarmed to the wireless method yet.
But it could be just a matter of time, advocates say.
"Once you get a little taste of it, you like it," explains Shelley Rauch, executive director of Westminster Village North, an Indianapolis-based continuing care retirement community.
A gentle expansion is going on in stand-alone facilities, too.
"We have a call system in one building (in Michigan), and we're looking at others," said Dennis Harris, director of plant operations for 60 Manor Care skilled nursing facilities.  "Company-wise, we've been looking at a number of systems."
With good test results, more systems will be put in place, Harris said. But this is one product class that cannot simply be bought in bulk.
They require custom outfitting and, most importantly, must obtain approval from state or other local licensing authorities. Life-safety and health codes most often require U.L. 1069 approval of devices, which mandates features most wireless systems often do not have, such as flashing dome-light alerts and other audible and visual notifications.
"You have to go with the local authority having jurisdiction," Harris said. Wisconsin wasn't allowing wireless tracking and security systems but Illinois and "a lot of others" have been more flexible, he said.
Waivers granting exceptions around U.L. 1069 and other specifications often are the way to go, sources explained. As many observers point out, most codes overseeing nurse-call systems were written before wireless technology became viable. The process to change the codes has not kept pace.
Proponents say wireless systems tend to make a facility less institutional. There may be fewer flashing lights, buzzers or loudspeaker announcements. Residents and workers can be more mobile.
"We love the fact that residents can call for help away from the standard pull cord and hope that has expanded the resident's universe," said Ed Soucy, director of capital and administrative purchasing for Genesis Health Care, Kennett Square, PA. One of his nursing homes in New Hampshire began testing a wireless nurse call system in April and another in Rhode Island was also approved at press time. Both systems are from HomeFree, the same Milwaukee-based firm Harris is working with.
Soucy may be poised to catch a bigger wireless wave.
"As we refurbish and upgrade facilities, we'll evaluate whether wireless will be appropriate," he said. Retrofitting a facility with wireless components rather than hard wiring clearly is one of the strongest attractions to wireless.
Another is some systems' ability to target only certain nurses for notification, and repeat broader calls as necessary if a resident's calls for help aren't  answered in a timely manner.
Beyond that, newer systems also can give providers detailed incident reporting, identifying individuals involved, service times, patterns and more.
One of the brightest bonuses with wireless is the ability to integrate reporting and other automated systems into it in the future, advocates say.

Concerns remain
But hurdles to wireless adoption remain. Many providers are reluctant to change routine. Also, residents may lose transmitters or otherwise be confused by operating parts of the system. In addition, only hard-wired systems allow voice communications between resident and caregiver.
Perhaps the biggest obstacle may be the thought of paying for something new while forsaking what's already working and hard-wired in place.
And then there's also the prospect of having to challenge existing code language and regulatory bureaucracy, which stop some in their tracks, before they ever really get started.
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