Wandering Care Feature — Exit strategy

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As providers begin to change their perception of elopement, technology is leading to more resident-centered monitoring.

The Armed Forces Retirement Home sits on 272 lush acres
in Washington, D.C. Natural attractions include a nine-hole golf course and two lakes.
It's the type of setting that would inspire most people to roam.
And they should, believes facility CEO Tim Cox. Most of his residents, including those with dementia, should be able to sit and watch geese on a lake and stroll on an outdoor path without arousing anxiety among their caregivers.
"Right now, they don't have the opportunity unless we have an activity there," Cox says. "It has to be forced."
But the continuing care retirement community is inching closer to such a world, thanks to new technology. As healthcare has begun to examine more closely the issue and ethics of wandering, systems that monitor it are now factoring in the importance of resident dignity and quality of life.
"Technology is starting to turn the corner in looking at elopement, not just from the side of assisting the facility and preventing elopement, but now some systems can locate the resident who has eloped, which is a big step for them to do," says David Meek, elopement specialist with the National Institute for Elopement Prevention and Resolution.
Little by little, nursing homes are catching on to the idea of a resident-centered approach to wandering. They are looking for systems that enhance rather than detract from residents' nursing home experiences.
Cox is looking forward to the installation of a wireless wandering system in his new dementia unit and throughout the grounds, including the golf course and near the lake. (He gained 200 of the campus's 1,300 residents last year after evacuating residents from a sister facility in Gulfport, MS, following Hurricane Katrina.)
If a resident is walking and touches an open gate that leads to the lake, an alarm will alert security to check on the resident.
"I just love the independence and the dignity that it gives people who can't describe why they want to go, but they need to go," Cox says.

A clinical issue
Wandering technology is moving into the clinical realm, so facilities can track resident behavior, rather than just lock them inside, believes Joe Whitt, vice president of sales and marketing for HomeFree Systems Inc. of Milwaukee. His system works with resident wristwatches. If a resident is approaching a door or sensitive area, the watch sends a signal through a wireless network. Nurses who pick up the signal on their pagers or computer can then check on the resident.
Whitt says his system, which keeps data, allows providers to track residents' patterns. In other words, if a person who has never tried to leave the facility suddenly makes an attempt, the facility can try to figure out why.
"Wandering is a result of a disease," Whitt says. "You need a proactive system to assist you with how you treat the disease."
Besides providing more information on each resident, such a wandering system may help caregivers as well. As a result of knowing where residents are, staff can make better use of their time.
"It won't necessarily reduce hours, but it will make them more productive," Cox notes.
In addition to the opportunity for an enhanced quality of life, wandering systems also are catering to providers' need for quieter spaces. Technology that is minimally invasive is becoming a growing priority among facilities, companies say. And that is true whether the system targets wandering or fall prevention.
"We're told by a couple corporations that they have seen that the facilities that are quieter receive less problems from state inspectors – less write-ups and citations and compliance problems," says Tim Long, president of Smart Caregiver, which makes fall prevention and wandering equipment.
"With our current systems, they can alarm quietly," he says. "They can go to a nurse call light system or via pager when someone is getting out of a bed or breaching a door."

Basic needs
While caregivers are thinking more about their residents' needs when it comes to purchasing a wandering system, they are also thinking about more basic things, such as the reliability and quality of the technology.
"They want the systems to work when it's supposed to work and be 'false-alarm free,'" says James Lyle, CEO of Alpha Watch Inc., which is based in Quakertown, PA.
Howie Groff, CEO and president of Tealwood Care Centers of Bloomington, MN, said that he has become more aware of the importance of a system that has a backup in case of an emergency.
"The one problem you have is that if you have a computer glitch or an interruption in electricity, you lose everything," he says.
Much of the new wireless technology works with pocket pagers and desktop computers.
"I know that staff turnover can be a big problem for a lot of facilities," says Lorna Schaefer, national sales manager of long-term care for RF Technologies, which has a wireless emergency call system. "The system has to be pretty easy to understand."

Cost also continues to play a role in the decision making process – in some cases to the detriment of other important factors.
For example, while there is growing interest among facilities for more resident-centered systems, price precludes most from taking advantage of this tracking technology, vendors say.
"Are more facilities looking for more of these types of systems? Yes," Schaefer says. "But is it the majority of facilities? No."
"The majority of nursing homes are looking for something inexpensive that works," adds Lyle of Alpha Watch.
Wandering systems typically have two major price considerations – the upfront cost of the hardware, and the long-term costs of the tags that are worn by residents.
Lyle, whose company offers a less expensive, "EZ" system, and "Platinum," a higher-priced premium product, says that he works with customers to figure out what systems they require to accommodate their needs.
Other issues of importance? Endurance of the technology and integration – the ability for wandering systems to work with MDS and accounting systems.

Hopes for GPS
But when it comes to their wish list, many facilities revisit the idea of better resident tracking. Many facilities are hoping Global Positioning Systems are a possibility in the future. GPS, a satellite-based navigation system, allows for ground receivers to pinpoint their exact location — longitude, latitude and altitude — anywhere on earth.
Is this a reality? That is not as clear.
"The cost will probably never allow it, probably in my lifetime," says Long of Smart Caregiver.
Also, the wattage of the transmitter would be too powerful to use in a hospital or other location, he says.
The military currently uses GPS to target various weapons, as well as improve command of forces. More commonly, GPS is available for car owners as personal navigation devices.
Facilities say this technology would give their residents even more freedom to roam and a chance to keep up with residents when they return home. It would also lead to quieter, more humane, facilities, according to Steven Shields, CEO of Meadowlark Hills Retirement Community in Manhattan, KS.
"I'm eager for the time when monitoring systems are mainstreamed with GPS so alarms aren't even a part of our life," Shields says.

Defining the problem

Nursing homes need to come to terms with the issue of wandering, says David Meek.
An "exit seeker," for example, is much different from a "wanderer." And "to elope" does not always mean to leave a facility.
"There is not a federal definition of elopement," explains Meek, elopement specialist with the National Institute for Elopement Prevention and Resolution. "A wandering person can be at risk for elopement. Wandering is not the same as exit-seeking behavior."
A better understanding of wandering would help facilities be better able to track and assess residents. Technology is available, but many facilities don't use it properly, Meek says.
"With alarming frequency, residents are eloping without leaving the facility," explains Meek. "A lot of people are uneducated on what elopement is."
Meek's organization defines elopement as "when a patient wanders away, walks away, runs away, escapes, or otherwise leaves a care-giving facility or environment unsupervised, unnoticed, and/or prior to their scheduled discharge."
One of the most disturbing examples of elopement within a facility occurred in Delaware in 2002 when a resident with dementia got locked in a freezer for nearly five hours. She died from complications resulting from hypothermia. The incident sent shockwaves throughout the industry.