McKnight's Long-Term Care News, October 2018, Feature 1, Resident Security
Tools to detect and prevent elopement and falls become even more interesting when combined with embedded cameras that detect things like movement, heat, height, objects and faces, observers say.

It wasn’t that long along ago that door-activated alarms and an alert nurse were the only thing standing between a wandering resident and a world full of hurt.

Today, so much of resident security nomenclature, procedures and equipment are inspired by the emergency preparedness field. Think “situational awareness” and “active shooter,” for two examples.

Behind all that technology today is another, deeper layer that many operators may not even be aware of.

“There’s been a major shift in resident safety technologies like wander management from alerting solutions to management solutions,” observes Steve Elder, director of communications for STANLEY Healthcare.

That deeper layer involves data, which by virtue of how it is mined, collected and analyzed, is arguably another form of technology.

“Wander management solutions are now part of the process for managing residents who show signs of wandering — the information they provide about when wandering is happening can be reflected in care plans so that the behavior is anticipated before it occurs,” Elder adds. “The result is more personalized care and protection of the resident’s dignity, while caregivers are empowered to focus on proactive care delivery rather than just responding to events.”

That extra layer helps nursing homes and others that care for the frail elderly to have a more holistic view of risk. As Elder explains, protection systems now offer a lot more visibility over current status — not just of individuals who need help, but of the community overall.

Various technologies, some borne out of military and industrial applications, are now prevalent, especially in tracking. These include radio frequency, infrared and global positioning systems.

Some of the more nascent resident security tech is now beginning to use facial and noise recognition — far more robust proactive measures that ward off unwanted intrusions while identifying frequent flyers among those most susceptible to elopement.

‘Added staff member’

James Jansen, technology solutions product manager for Direct Supply, notes how these technologies are integrated into video surveillance.

“Cameras can act as a deterrent for challenges involving violence, theft and other behavior communities wish to curb,” he says. “These same cameras have a growing list of analytics, such as facial recognition and noise detection, to essentially act as an added staff member to notify and respond to events such as elopement or active shooter scenarios.”

Take a camera. It could recognize a certain individual, and when integrated to an access control system, tell the door to lock or unlock based on a facial recognition analytic, Jansen adds. Or the camera could hear a loud noise, such as a gunshot, and send a notification to staff while telling the building doors to go into lockdown mode.

Facial recognition is rapidly becoming more sophisticated, and can be a powerful tool in anticipating and preventing potential gun violence, according to Dan Wicker, product consultant for HD Supply.

“Because not every threat is a known person, systems can also be programmed to look for common abnormalities such as a long coat in summer, covered face, or threatening objects,” Wicker says. This can easily be paired with a modern notification system that most communities are already using, and the systems can send a text, email and/or phone call, lock or unlock doors, and even call the police department simultaneously, he adds.

The role of artificial intelligence cannot be understated.

Both AI and predictive analytics “allow you to respond to the exact door the resident exited from or intervene before two residents meet,” Wicker notes. In addition, modern systems can store photos of all residents, and when an elopement is discovered, the report is accompanied with a current photo.

“I can tell you from experience that looking for a person you don’t know well or not at all can easily end with you walking right past them,” he says.

Real-time location systems  another technology generated in military applications, is one of the most widely used in many security devices like wearables inside skilled nursing facilities. One of the most popular applications is elopement detection and prevention, and more recently, falls detection and prevention, says Martin Rokicki, chief executive officer of Skynet Healthcare Technologies.

The core of its value lies in speed, adds Wicker.

“Two key benefits with current and emerging tech are the access to quality information and the speed in which this data can be delivered,” he says.

The tech becomes even more interesting when it’s combined with embedded cameras programmed to detect things like movement, heat, height, facial and object recognition.

Chief Business Officer Jerry Wilmink says his company, CarePredict Inc., utilizes “deep learning,” a sophisticated type of sensor- and wearables-based machine learning, to mine data around residents’ activities of daily living. The data is coupled with what Wilmink calls “contextual cues” to gather insights like self-neglect, fall prediction, unusual behavior patterns, malnutrition and dehydration, “all without any self-reporting by the senior or need for a constant human observer.”

People power

Until robots replace caregivers, all of this sophisticated technology can easily be hacked and handicapped if it’s managed by people who aren’t vigilant, lack common sense or are unable to think on their feet.

Says Brad Hyder, marketing manager at TekTone Healthcare Communications: “From hiring the right staff to choosing the right medical equipment, management teams must be confident that the solutions they are choosing will yield the highest amount of resident protection.”

Paul Larson, vice president, new product development and engineering services for RF Technologies, believes today’s most effective resident security melds resident behavior monitoring with the use of a wander management system.

“Infrequently-used doors should always be locked with a delayed egress lock, and frequently-used doors should be monitored during the day and locked during the night, even when a wander management system is used,” he says.

Experts agree that being attentive to resident behaviors of all kinds — whether aberrant or normal — is something even today’s most sophisticated artificial intelligence and predictive analytics could miss.

“Sensors, sensor fusion, algorithms, learning abilities of AI systems and prediction capabilities are all improving and enhancing the prevention capabilities,” says Majd Alwan, Ph.D., senior vice president of technology for LeadingAge. “However, the human assessment and observer’s input is extremely valuable when it comes to identifying, and trying to avoid or eliminate such triggers or problematic behaviors or root causes.”

Alwan, who also serves as executive director of the Center for Aging Services Technologies (CAST), evaluates myriad tech of all kinds for senior living. He believes the old adage about an ounce of prevention being worth a pound of cure. This includes assessing residents, addressing causes for adverse events like falls and wandering, having multiple in-depth defense and prevention measures and regular re-assessment and evaluation of the residents and all measures taken to protect them.

Given all of the tech and people power, meanwhile, it’s safe to say the risks are greater than ever.

Some observers believe more residents today are hostile and unpredictable, arguing they are merely a reflection of a society that is arguably more hostile and unpredictable. Powerful and sometimes unpredictable medications also can be a culprit.

“As facilities expand and organizations consolidate and migrate from serving limited specific populations to offering a broad range of care models, such as independent living to dependent care to skilled nursing, the range of security challenges increases,” explains Michele York, product marketing manager for Secure Care Products LLC.

“Certainly with rising acuity levels and other factors, communities face a more complex safety landscape,” adds STANLEY’s Elder. “This is what is driving the adoption of more sophisticated technologies,” Elder adds.

Like anything, the wave of innovation sweeping resident security could leave some staff feeling overwhelmed. Still, tech adoption in this space is a fait accompli.

“Predictive technology and AI are much more widely available now than they were just a few years ago, and seemingly finding new applications all the time,” observes York. “While we have not seen long-term care making significant investments in such high technology yet, it’s only a matter of time.”

Intriguing future

Larson believes the use of artificial intelligence for predictive analytics “will be part of a big trend in the future to take advantage of the mountains of data collected by today’s top systems. As tracking capabilities and battery life improve, and the associated costs come down, solutions like geo-fencing and outdoor tracking of elopers will become more prevalent.”

In the years to come, the operative word is integration.

“We’re going to see integration of more kinds of systems to provide a detailed and nuanced view of each resident,” Elder says. “This will include more, and more sophisticated, systems within the senior living community — the EMR, wellness monitors, real-time location systems and others — but also consumer devices like wearables, smart medication management systems and connected health monitors like scale sand blood pressure monitors.”