Stepping up to safety
Stepping up to safety
Up to 60% of all assisted living residents are affected by dementia, and three out of five will wander as a way of coping with their condition-related confusion and restlessness, the Alzheimer's Association reports. Although wandering can occur safely in a controlled, monitored environment, not all senior living communities are doing enough to keep residents out of harm's way.
Statistics are grim for those with dementia who venture off unsupervised. More than half who elope die if not located within 24 hours, statistics show. Death and serious injury can occur within minutes, however, as one Indiana assisted living facility discovered last year after an elderly resident with dementia was fatally struck by a car just moments after wandering offsite.
Unsafe wandering and elopement can be avoided if senior housing operators take steps to proactively manage the risks. (See related story.) Experts agree that ongoing staff training and carefully developed policies and procedures — along with the adoption of resident security technologies that promote dignity and freedom while maintaining safety — is the most effective approach.
“Most communities approach wandering as a facet of a resident's dementia, which requires a number of interventions,” said Steve Elder, senior marketing manager at STANLEY Healthcare.
Some operators may be intimidated by resident monitoring solutions and reluctant to adopt them because of noise concerns, training requirements, installation challenges or the fear that technology will create an intrusive, institutional feel. Fortunately, today's solutions are more discreet, cost-effective and easy to use than ever.
Many of today's wander management solutions are silencing loud alarms and instead sending inaudible alerts to nurse stations, smartphones and mobile pagers. These silent notifications incorporate accountability and safety features that ensure caregivers respond to incidents promptly and accurately.
“We are hearing that [operators] are wanting to get away from alarms, but it's not practical to eliminate them altogether,” said Jared Pitney, vice president of RF Technologies' Senior Living Division. Silent alarms make it possible to eliminate alarm fatigue and reduce excessive noise that can agitate residents, visitors and employees, while still alerting caregivers in real time of potentially dangerous wandering, falls, elopement incidents and more, he said.
Because it often is difficult to know with certainty whether a resident is an elopement risk, communities should consider comprehensive security solutions that can help monitor the perimeter of the building and residents with or without tags, reasoned Bob Vinditti, engineering manager for Philips Lifeline. Many modern solutions are making institutional door lockdowns a thing of the past while incorporating components that blend with residential-inspired aesthetics. Systems may feature lowprofile door controllers with discreet keypads, for example, that seamlessly blend with the residential setting, and unobtrusive resident-worn bracelets, pendants and tags that can be tailored to each resident's unique and changing needs. Some wall-mounted transmitters even can be camouflaged with custom-printed graphics or images that match a resident's memory box outside his or her room, or otherwise mirror a resident's interests or the community's design aesthetic. “Many operators don't want to brand a resident, and this helps take the stigma away,” Pitney said.
Resident identification is another key feature of today's wander management solutions, although it is still not widely adopted, according to Vinditti. “It's important for operators to feel confident they are looking for and securing the right resident who has wandered.”
The shift away from stand-alone technologies continues to trend as operators look to integrate their resident security solutions and pool data to enhance response times and decision-making capabilities.
“We're seeing a consolidation of alerting systems in the healthcare industry,” said Chris Konicek, sales and marketing director for Accutech Security. “Communities aren't interested in three different computers for three different systems.” Accutech is working to provide reliable, scalable, cost-effective solutions that integrate with as many existing systems as possible, he said, adding that Accutech's LS 2400 system directly integrates with most major nurse call providers.
Many wandering incidents happen at night, so knowing when the resident is about to leave or already has left the bed can help staff quickly and safely redirect the resident, while also reducing the risk for falls. Bed exit solutions that allow the information to reach the caregiver in a timely fashion, without bothering or scaring the residents, are key, stressed Maayan Wenderow, director of marketing for EarlySense. The company's new InSight solution sends all information to a central display and caregivers' handheld devices or tablets. “The information is actionable and allows immediate intervention by staff, if needed.”
Automatic fall detection is a critical feature for wander-prone residents because many residents may not have the instinct to call for help themselves, Vinditti added. Philips Lifeline's CarePoint 5.0 solution goes beyond standard help buttons to include the AutoAlert fall-detection technology.
As with any technology, practical application lies at the heart of these solutions' long-term success. The more data points systems can offer caregivers and the better their reporting capabilities, the better equipped caregivers will be to deliver effective, resident-focused care decisions and response, Pitney explained. RF Technologies' Sensatec fall management alarm solution integrates with the company's Code Alert nurse call system to silently alert caregivers at a central computing station or via a mobile device and allow staff to respond to incidents faster. With the nurse call system, caregivers must physically go to the resident's bed to reset the alarm and appropriately clear the pendant.
“It's important to make sure staff understands [alert] escalation and how to clear the alarm, and also how to utilize the reports fully,” Pitney added. RF Technologies is developing training modules to provide staff with remote access education to simplify use and make the most of the technology.
DATA DRIVES RESULTS
As beneficial as technology is, experts stress the most important thing is understanding the resident and using technology as a complementary component to comprehensive and ongoing resident assessments. “Technology should never be a substitute for human involvement,” said Todd Stanley, senior product manager for Inovonics.
Upon admission and on a routine basis, residents should undergo a comprehensive risk assessment for resident wandering, notes Melinda Laupert, RN, of the McKesson Medical-Surgical Clinical Resource Team. She recommended developing and implementing a variety of resident-specific approaches that address wandering and elopement risks.
“Begin with keeping a daily log to identify changes in resident behaviors and mood,” she said. “Make notes [about] behavior patterns, such as pacing, anxiety and anger, that may lead to wandering.”
Among other steps, Laupert advocates interviewing family and friends regarding a resident's prior hobbies, interests, routines and profession, so they can be integrated into the resident's daily schedule.
Silverado communities use information gleaned during initial resident assessments to redirect the individual in community clubs and workshops based on their interests. “When a resident wishes to leave the community, we ask them why. We listen to them. Sometimes, validating their feelings is all they wanted,” said Kathy Greene, MSW, senior vice president of program and services integration at Silverado. She further pointed out that pacing is one way a memory-impaired person might communicate pain. One Silverado resident in Austin, TX, repeatedly tried to elope and chronic pain was determined to be the culprit. “Since being treated for [the pain], she has not attempted to leave. She now engages in social programs with other residents.”