Up to 60% of all assisted living residents have memory loss, and as many as 6 out of 10 of those residents wander as a way of coping with dementia-related anxiety, confusion and restlessness.
While the act of wandering isn't always dangerous for the resident, if it's not done in a safe and controlled environment, it can lead to falls, elopement or even death. In May, an 86-year-old assisted living resident in Maryland with dementia wandered from his facility into the street, and died after being struck by a car. Such devastating events are hardly isolated; however, experts agree they can largely be prevented with a comprehensive resident safety plan.
“Taking measures to improve safety can prevent injuries and help a person with dementia feel more relaxed, less overwhelmed and maintain his or her independence longer,” the Alzheimer's Association notes.
Assisted living operators are heeding that advice. Many are designing thoughtful indoor and outdoor spaces that encourage safe wandering. They're also engaging in ongoing staff education to help identify at-risk residents, and developing individualized care plans to reduce the risk of dangerous wandering, falls and elopement. As an added layer of protection, operators are employing modern, discreet and unobtrusive wander management solutions that let residents roam safely, promote autonomy, and promptly alert staff to falls, elopement, behavioral changes, or other events.
“The promise of technology is in preventing bad things from happening and/or facilitating the appropriate response if an emergency occurs,” says Mike MacLeod, president and co-founder of Status Solutions LLC.
Gone are the days where wander management requires loud alarms and institutional door lock-downs. Today's innovative solutions may include low-profile door controllers with discreet keypads that seamlessly blend with the residential setting, and resident-worn bands, pendants and tags that can be set and adjusted to meet resident's unique and evolving needs.
“We believe if you enter a dementia care area with wander management and you notice the emergency call system, whether it's audio with buzzers or alarm announcements, or visual with flashing lights and such, the system is outdated,” notes CISCOR CEO Sam Youngwirth. “Systems should blend into the environment and should not induce stress to the resident.”
A basic, intelligent wander management solution will include a transmitter for the resident to wear, and sensors at each of the doors to sound an alarm when the monitored resident approaches. Entry-level systems won't do much beyond sounding the alarm, and possibly locking the door preventing the resident from eloping, points out Laurence Yudkovitch, product manager for RF Technologies.
“While this satisfies the basic requirements for protecting at-risk residents, it does so at the expense of adding noise to the environment, and still requires a caregiver to be within earshot of the alarm.” Smarter, integrated solutions include remote alerting capabilities, allowing the caregivers to be anywhere in the facility and receive a page, SMS or email if a monitored resident elopes. “By reducing or eliminating the audio alarm, these systems improve the ambience of the facility, decrease disruption to other residents and free up caregivers to perform other activities,”
Yudkovitch notes, adding that aesthetics are also part of modern-day wander management solution design. RF Technologies' Touch Pad Exit (TEC) controller turns off the backlight when not in use, so it blends into the background and helps promote the home-like feeling. Similarly, facilities can forgo the bulky black transmitters residents wore in the past and opt instead for discreet, lightweight transmitters that are as comfortable as a wrist watch and feature calming, colorful designs.
Many of the latest wander management solutions also integrate with other resident security systems, such as emergency call, security and fire panels, telemetry, access control, mobile alerting and reporting systems, closed circuit televisions, and more.
“The ability to integrate these systems has gotten easier over the last few years. Oftentimes, there can be significant savings by integrating these systems via comprehensive technology design that takes into consideration how care staff interact with all of the systems,” notes Wes Columbia, technology studio lead for Direct Supply Aptura.
Enhanced integration and interoperability makes it easier than ever for staff to monitor alarms and security events, and then use that data to pinpoint resident patterns and provide more flexible, individualized care.
“As an industry, we're moving from a reactive mentality to a much more proactive one of trying to get in front of an incident using predictive technologies,” says Youngwirth. “We know that when a resident deviates from their norm, the probability of an incident can increase.”
CISCOR's system helps caregivers learn individual resident patterns and sends an alert when a resident deviates from his or her norm. This allows caregivers to intervene before an event occurs.
Customized alerts are also paramount to providing personalized resident care and response. As part of the Code Alert Wander Management system offered by RF Technologies, model T80 TEC can uniquely identify each monitored resident at the door. Aside from allowing customized alerts that inform the caregiver which resident is loitering or eloping, advanced analytic capabilities in the software let caregivers track and trend resident behavior over time. This information can be used to detect changes in a resident's condition, and help determine alternate care plans, according to Yudkovitch.
“If a resident starts generating a number of loiter alarms consistently over a couple of days, for example, that can serve as advanced warning that the resident may be at a higher risk for eloping, and trigger the staff to create an alternate program to re-engage the resident,” he says.
Video enhancements add another level of specificity to alerts. A facility can use video paging to visualize door alarms to prevent elopement, notes MacLeod.
“Sometimes, residents with wander-prevention bracelets can trigger an alarm because they're in the general vicinity of the door, not because they are trying to walk out,” he says. “If staff can see that a false trigger has occurred, they don't have to deploy resources to investigate.”
Giving caregivers ready access to real-time, resident-specific information from their smart technology — anywhere and at any time — enhances staff response that results in better resident care.
“Care operators can assess, predict and report any incident from one central location, or from anywhere in the facility,” says Jack Zhang, CEO of CaerVision Global Inc. “With facial recognition, voice activation and wearable devices, senior living organizations can remain confident that residents will not [engage in unsafe wandering].”
CaerVision recently acquired Vitall Inc., a provider of resident safety and monitoring technology. Vitall's wearable, in-room monitoring solutions provide round-the-clock emergency support from a centralized facility. The technology controls security access/entry, intelligent environmental controls for lighting and room temperature, CCTV, data/voice communication cabling, datacenter management, wireless infrastructure, and audio-visual controls.
Expanding the reach
Wander management solution providers also are taking advantage of increasingly budget-friendly and reliable real-time location systems that can be used both indoors and outdoors. In some cases, the technology offers an alternative to obtrusive door locking and anti-elopement systems, which can have visually or auditorally disruptive alarms.
“An effective RTLS solution, while allowing residents the freedom to move freely throughout a facility, can ensure residents' safety by providing detailed — and often quiet — real-time scenario notifications that are distributed to conveniently located staff and/or nurse stations,” says Rachel Owens, VP of product management for PointRF. “This enables situations such as an unsafe area entry to be addressed quickly, before an event occurs.”
Add-on accessories can further enhance the data generated by an RTLS solution. Internal pedometers and accelerometers in wandering bands that are part of a building-wide RTLS, such as the PointRF NoWander platform, can provide ambulation trend information. This can play a role in fall risk management and therapy needs assessments, according to Owens.
However advanced today's wander management solutions may be, experts agree that their benefits won't be realized if staff aren't doing their part. The bottom line, the experts concur, is that staff must be committed to analyzing captured data to drive improvements and provide the most appropriate, resident-centric care.
“If a resident has a propensity to ‘go home after work' as the sun is going down — a common issue for many residents — staff can use that information to structure activities during the time following dinner,” says Columbia. This allows the resident to stay active and engaged while reducing the risk of elopement.
Staff must also understand that technology can't do its job effectively without human intervention.
“What if the batteries on the resident's device fail? What if [the resident] gets out the door with a visitor? What if they ‘crack the code'? These are things to consider,” reminds Eric Masters, VP of marketing for Relias Learning.
He also points out that staff should rely on their training to determine who is at risk for elopement or wandering to another section of the building, and what they must do to help return a resident to their designated area.
“Education and awareness, as well as adherence to company policy and manufacturer instructions on technology upkeep and maintenance, may be even more important than the technology itself,” he adds.