Beyond bells and whistles.

Nursing Homes has reported frequently over the years on developments in resident monitoring (aka "departure alert" or "anti-wandering") equipment - most recently, on ECRI guidelines ("Wandering and Elopement Technologies: A Guide," October 1996), the Manor HealthCare approach ("Making the Most of Wander Control Technology," February 1996) and vendors' observations ("Wanderer Departure Systems: High-Tech, Low-Worry," March 1995). These systems are always evolving, though, and modern electronics have moved these devices long past the bells and whistles of yesteryear. Rummaging through our voluminous mail bag (and voluminous it is), we came across these recent press announcements about products and product developments that give some inkling about where this field is heading. As we parphrase them:

From Wanderguard - a company whose name has "entered the language" as a generic description of such devices (for better or worse from the company's standpoint) - comes the announcement of its Vitalcall wireless call system. Residents can signal calls for assistance from either fixed wall transmitters or portable pendants located anywhere in a monitored area. Staff receives these calls on personal pagers and centralized received units, with the calls continuing to be displayed until they are answered and cancelled by staff. One big advantage of a system such as this, of course, is that no messy and expensive wiring or rewiring is required. And it covers the entire monitored area, allowing residents mobility under continuing safe conditions.

RF Technologies, the makers of Code Alert, has also ventured into the wireless field with its new Quick Response Emergency Call System. A touch of the resident's pendant transmits the call to a Pentium-based PC computer that not only activates audible and visual alarms, but identifies the resident and his/her location. That same program also displays resident medical and personal contact information for use during or after the search. High-frequency technology offers greater range and interference-free operation, says the manufacturer, which also offers on-site staff pagers as an option. Again, wiring concerns are banished with this approach.

Secure Care Products weighs in with its Wandering Resident ID system which (as the name suggests) identifies any monitored resident or group of residents who approach a facility exit - displaying each resident's name, room number and location on the nurse console and automatically locking the door. For the staff's security, selected doors can be programmed to lock automatically during nighttime hours as well. An important feature, in keeping with fire protection life safety codes, is an electronic magnet that will release a locked door within 15 seconds whenever a force of not more than 15 pounds is applied to the door for not more than 3 seconds. Residents who are unaware of this, of course, would likely try to push and shove the door repeatedly during that 15 seconds, thus keeping it locked. The system also has a fire alarm interface and emergency back-up battery, among other features.

The Instantel WatchMate System continuously monitors residents individually and in groups and displays identification and location information for any approaching an exit. Staff can escort residents in groups up to ten through exits without sounding alarms simply by pre-identifying the residents on the monitor; those who are not identified will still sound off the alarm. The system, consisting of wrist-mounted transmitters and out-of-the-way monitoring units, is versatile, capable of protecting doors, hallways, elevators, stairways and outdoor patios, and activating such disparate devices as magnetic door locks, video cameras and external alarms. Design and reach of the system can be customized to the facility. The system also boasts interference-free FM technology.

Finally, a "work in progress" is the EZ-Watch System under development by Label Tape_ Systems. Slated for market release soon, this employs transmitters sewn into resident's clothing, monitored by door-mounted sensors. The company, inspired by department store anti-theft technology that sounds an alarm when unpaid-for boxes and packages exit the store, set out to find resident-wearable transmitters that would be accurate, reliable, and yet bear up under the repeated washings and foldings applied to residents' clothing in institutional laundries (not a concern, of course, for package-mounted devices). Most devices tested could not withstand high-temperature iron-on applications or a set of 500 washings and dryings until the company located magnetic targets commonly applied to more expensive consumer items, such as cameras, notebook computers, etc. These survived the tests plus the added torture of employees wearing them on the insides of their shoes for several months to test for anti-abrasive properties. Submitted to all this, they achieved 80% accuracy - the commercial standard, but obviously not good enough for long-term care facilities. Further rejiggering of the devices and sensors brought the product to 100%, the company reports, and it is now field-testing them in selected beta-site facilities through the end of March. The company expects a product announcement shortly thereafter.

All these companies and more in the field are continuing to push technological boundaries to achieve the product "ideal": reliable, accurate monitoring and control with a light touch, allowing maximum permissable independence under safe conditions. Stay tuned to see how far they take it.