A sense of presence

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A sense of presence
A sense of presence
Even the most budget-conscious communities can leverage technology to improve resident care and staff efficiency, while also gaining a competitive edge.Monitoring and sensor solutions offer residents a higher degree of safety and security. They also allow staff to monitor activities of daily living and quickly and objectively assess wellness conditions—key advantages that facilitate prompt diagnosis and treatment of emergent, or even pre-emergent, conditions.

And that's just for starters. If technology is utilized effectively, providers will be able to keep residents living longer at lower levels of care, assures Jim Reilly, director of Courtland Healthcare Technologies, a subsidiary of Philadelphia-based senior care services provider NewCourtland. Further, he reasons that providers can utilize the data for critical decision-making to help establish the most effective resident care plan.

Remote wireless monitoring technologies are noninvasive, with some systems integrating motion sensors, contact and pressure sensors, and resident call buttons that operate in real-time.

Cost considerations

The technology has become increasingly cost-effective, allowing even the most budget-conscious communities to leverge technology to improve resident care and staff efficiency, while also gaining a competitive edge.

“Major challenges” are reducing costs without compromise and maintaining resident dignity and privacy. “Sensors combined with intelligent processing of sensor data can help handle both challenges,” adds Stuart Lipoff, chairman of the IEEE Consumer Electronics Society Standards Committee.

In recent years, he says, the cost, size and weight of sensor technology have dropped, making it easier for operators to acquire and implement them.  Most facilities now have data communications and Internet infrastructure in place, such as Wi-Fi, which mitigates the need to install special infrastructure for resident monitoring, he adds.

Systems ‘smarter'

Some facilities that have made the leap to sensor technology are realizing a rapid return on their investment. At Quaker Gardens, a 170-unit senior living facility in Orange County, CA, for example, remote monitoring solutions have helped on numerous occasions to identify early-onset medical conditions, adverse medication events, falls and other concerns that, if not promptly addressed, could have led to hospitalization or other negative outcomes.

Using GE Healthcare's Quiet-Care motion-sensing system, Quaker Gardens staff establish a baseline for each resident, and then set specific parameters within the system to send out caregiver alerts if a deviation in a resident's normal pattern occurs.

“If a resident's normal routine is 30 minutes in the bathroom, for example, we can [program] the system to send out an alert and have staff automatically respond if that resident is in the bathroom longer,” notes Claudia Lusca, LVN, clinic director for assisted living at Quaker Gardens. “We have had some incidences where alerts went off and staff went in and found a resident on the floor. With the sensors, we were able to respond within minutes.”

Because many seniors may not inform staff of changes in their physical, cognitive or emotional status, sensory technology can alert caregivers to potential problems and prompt intervention before their situations worsen.

“Typically, seniors don't like to self-report potential problems or issues they may be having, and most care is based on subjective information received from the resident based on direct questions and feedback, ” says Jeff Noce, president and CEO of WellAWARE Systems, Charlottesville, VA. “Also, in many cases, seniors experience some form of dementia, so passive monitoring systems can help provide insight into conditions when a resident may not be able to clearly articulate what is wrong.”

Recently, the sensor technology at Quaker Gardens issued an automatic alert to staff when a resident frequented the restroom more than normal. This spurred a thorough assessment the very next day.

“We promptly notified the physician and ran a urinary analysis, and a UTI was confirmed. If this hadn't been detected so quickly, it could have become a systemic infection and she could have required hospitalization,” Lusca explains.

Seeking patterns

NewCourtland facilities also install a variety of sensors in strategic areas of each unit to “learn” residents' daily activities and detect unexplained changes.

As Reilly explains, this may include contact sensors on kitchen cupboards and refrigerator doors to monitor whether the resident is eating regularly, tilt sensors on medicine boxes to monitor medication usage, motion detectors on walls to detect movement or inactivity, pressure sensors on beds to detect when a resident gets in or out of bed, toilet sensors, and home-or-away-sensors that can detect when the resident leaves or returns to the residence.

Courtland HT's operating system analyzes the sensor data to determine whether the resident requires assistance and automatically issues alerts as needed.

“Among the benefits for both residents and providers is the ability to direct staff to respond to a resident's needs for assistance, passively manage resident-specific risk behaviors, provide chronic disease monitoring and real-time ADL monitoring, prompt residents to perform activities of daily living, and remind staff of resident care plans,” Reilly says.

System scalability and flexibility are at the heart of today's technology, allowing providers to provide truly customized monitoring that can be easily adjusted as residents' needs change.

Each facility is different and each resident within a community is different, so technology “will only be effective if it's flexible,” explains Robert Heppenheimer, managing partner of Focus Solutions LLC in Melville, NY.

Rule sets can be placed on each individual resident, and those rule sets can change over even a 24-hour period. These rule sets establish the parameters [in which] alerts are activated. If a resident is injured or ill and may be at greater risk for a fall, for example, caregivers can adjust the rule sets to trigger an alarm if that resident attempts to rise from bed without assistance.

To avoid unnecessary interruptions, systems can allow notifications to be specifically directed to nearby personnel, with alerts being appropriately escalated if a response isn't provided in a defined time period.

“In addition, staff can request assistance from their colleagues without leaving the resident in need,” says Mark Rheault, president and CEO of Intelligent InSites, Fargo, ND.

More high-tech sensor and data gathering technology is making its way into long-term care. Sensors can work in tandem with vital signs monitors and automatically notify caregivers when vitals move outside a resident's normal range, for example.

Measuring breaths

They may also be embedded in bed pads to monitor heartbeats and breaths per minute so staff not only can determine a resident is in bed, but is actually asleep.

“Sleep is one of the first things impacted by the development of a chronic condition. Sensors that can detect heart rate and REM sleep goes way beyond a pad that senses a person is in bed, but maybe not sleeping at all,” Noce says.

Humidity sensors also are available and can show whether a resident has showered, as opposed to assuming so because a motion sensor indicated that the resident entered the bathroom.

As resident data is automatically captured and potential problems are flagged, the system triages that information and prioritizes alerts so each day residents most in need are addressed first. “This increases staff efficiency and enhances quality care,” Noce says.

Real-time location system technology that monitors residents throughout the community can further enhance resident care and safety.

By combining strategically placed environmental sensors with resident-worn, wireless badges or call buttons, staff can enhance wander management, fall prevention and resident response community-wide.

Heading off dangers

Such an example might be when a resident who has difficulty walking down stairs approaches a stairwell or restricted area, such as an exit door.

“Based on the proximity of the resident to the area defined as a potential risk, the system immediately alerts staff, providing the resident's name, along with his or her current location,” Rheault says.

RTLS technology also can drive customer satisfaction by automatically monitoring resident participation in social events or wellness programs. Systems can alert staff to check in with a resident who typically attends a class, but is unexpectedly absent.

At the same time, automatically capturing residents' participation and involvement allows caregivers to share their engagement and interests with family members.
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