Wandering Feature: The next step

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Resident security technology is improving, thanks to scalable wandering systems that piggyback onto existing platforms.

Few events can be as frightening – and damaging – to providers as when a dementia resident wanders unescorted off the property or into an unsecured, potentially dangerous area of the facility.
The risks are mounting as more residents with Alzheimer's and other forms of dementia move in. Industry reports show that more than 60% of assisted living residents are cognitively impaired to at least some degree. Skilled nursing facilities, in all likelihood, have it worse.
Given those risks, it's little wonder so many providers are looking to incorporate the latest wander management solutions into their existing resident monitoring platforms and assessment protocols.
"Wandering is definitely a serious concern and consideration for providers. If they aren't yet dealing with residents who are at high risk for wandering and elopement behavior, chances are they will be in the near future," said Troy Griffith, president of Vigil Health Solutions Inc., Victoria, British Columbia.
That proactive stance is an obvious plus for both providers and residents. Not only do effective wander management solutions enable providers to accept more residents with dementia and other conditions that increase the risks of wandering behavior, they also allow these residents to safely stay in their current environments longer.
In the not-so-distant past, providers aiming to manage wandering with technology had few options. Often they combined the impractical task of providing constant supervision of at-risk residents with simplistic standalone wandering solutions whose features rarely extended beyond locks and alarms.
Not true today. Much like many other resident security technologies, the latest wandering solutions are offering new options and protections. They link with a range of complementary platforms that can improve caregiver response times, promote resident independence and maximize return on investment.

Custom solutions
Still, navigating through the many options can prove daunting, especially for providers who are not "tech friendly." To help narrow the scope, providers must first have a clear understanding of their own unique resident needs before committing to one particular solution.
"It definitely isn't one-size-fits-all. What works for one facility or resident may not be appropriate – or even necessary – for another," says Karen Merk, RN, BS, CNAC, clinical consultant for Briggs Corp., Des Moines, IA.
What many providers are finding purchase-worthy are computer-driven, scalable systems that can easily piggyback onto existing platforms. Not only does this promise improved resident monitoring and security, it dramatically cuts down on installation costs and allows for easier upgrading.
"There's much more in the way of integration these days, where wandering technology can be built into other monitoring solutions, such as nurse call. Wander management is really being recognized as a natural extension of that application," explained Joe Whitt, vice president of sales and marketing for Milwaukee-based HomeFree Inc., a global provider of wireless monitoring solutions for the senior housing and homecare markets. "As a result, systems are becoming smarter, more seamless and resident-centric. Today, it's more about understanding residents' movement patterns and the reasons behind their wandering rather than simply locking doors."
State-of-the-art software is behind the latest systems. Resident-worn transmitters that work with wireless receivers and door alarms to monitor resident location and alert staff are really catching on at facilities.
The key is to find solutions that can be customized to offer a range of options, says Raleigh Ormerod, marketing director for Stanley Senior Technologies, a division of Stanley Security Solutions. The company's WanderGuard product has the capability to interface with — and automatically lock — doors if a resident with a wristband transmitter approaches, but that function is an option, not a requirement.
"Another option is setting up sensors before the door so staff can detect resident patterns and movement earlier and have a better chance of stopping the resident before they have an opportunity to [exit]," he noted.
With some systems, an audible door alarm may sound when a resident breaches the barrier, and caregivers may also be silently alerted at the nurses' station or via two-way radio or pager. As another layer of security and resident identification, some software-driven solutions even display the resident's photo at the computer terminal when a wandering incident occurs.
"The smarts are in the software," said Steve Elder, communications specialist for VeriChip Corp., describing the company's RoamAlert radio frequency identification system, which, aside from wander management, brings the added advantage of asset tracking (using transmitters to monitor the location of wheelchairs and other equipment) and even high-level emergency response.
"This is a step up from traditional nurse call, because it moves with the resident and allows more freedom and independence without sacrificing safety," he added.
Even more scalable and more user-friendly are on the horizon. Vendors generally agree that within the next several years, wander management systems will become more standardized and LAN (Local Area Network)-based, allowing providers to easily plug into existing network cables. Resident-worn transmitters also will likely evolve, both in regard to longer-lasting battery power and more discreet applications. "I'd like to see the transmitters implemented in residents' shoes, for example," Merk said.
Even the best technology isn't foolproof and may be bypassed by some residents, noted Michael Chylewski, vice president of Care Trak International.
"There is value in being able to monitor locations on-premise and alert at the door, but what happens if someone actually does get away? It does happen, as the [reports] show," he said. All residents outfitted with Care Trak's RFID bracelets receive a unique registered frequency that allows them to be accurately tracked for miles. "If someone gets away, we will quickly find them."
Facilities that prefer to monitor resident wandering behavior without bracelets and audible alarms have additional options. Solutions such as the Vigil Dementia System by Vigil Health Solutions use strategically placed motion sensors in resident rooms and other areas that detect irregular behaviors, including wandering. If a resident moves beyond a designated perimeter, the system will send out a silent signal. This gives staff the opportunity to avert a possible incident before it arises, according to Vigil's Griffith.
"We have the philosophy that tags and bracelets can have a noxious affect on some residents. They simply won't work for everyone and facilities that rely solely on them for resident security are putting themselves and their residents at risk," he explained. "Our system was developed to combine the latest in perimeter monitoring technology with good facility design."

Beyond technology
However cutting edge today's wandering solutions may be, sources agree that providers should never underestimate the value of ongoing assessment and the implementation of comprehensive policies to addressing resident wandering.
Karen Suma, director of quality for Markham, Ontario-based Extendicare Inc., said the company takes a broad, facility-wide approach to wander management – one that blends technology and facility design with interdisciplinary assessment and individualized care plan development.
"Once we identify residents at risk and figure out their routines, we can then develop a care plan that best meets their unique needs," she said.
Understanding why residents wander is key. Suma explained that some residents try to leave if they are in a new environment and unfamiliar with their surroundings, and others may wander to expend energy.
"If we know that a particular resident tends to wander at a certain time of day, you can often redirect that impulse by taking them for a walk or engaging them in another activity," she noted, adding that such residents may do quite well in units that allow them to move freely in a secured area.
If wristbands are used, Ormerod recommends they be placed on a resident's dominant hand to make them more difficult to remove. Other steps to safeguard residents include posting updated photos of residents who have a tendency to wander near exits; developing an algorithm that outlines the steps to follow if a wandering resident exits the facility unescorted; and educating staff, visitors and family members on wander management and elopement prevention.