Comforting changes: in 25 years, long term care equipment has advanced to make residents' and caregivers' lives more comfortable.

If you're old enough to remember a time without cable TV, microwave ovens, videocassettes, cell phones and personal computers; a day when real-live operators answered telephones and rock stars made albums instead of videos; and a landscape devoid of Wal-Marts; then you've lived long enough to know that technology has changed nearly every aspect of our world.

Long term health care is no exception. In the 25 years that Contemporary Long Term Care has chronicled the industry, the equipment that defines "contemporary" has changed dramatically. The basic tasks our equipment performs remain much the same, of course. We sleep in beds, roll around in wheelchairs and cushion patients against the hard edges of their environment. Nor nave we advanced so far that Judy Jetson (are you old enough to remember her?) would fee at home.

What has changed in 25 years? Comfort. Just as cell phones deliver the warmth of a friend's voice nearly anywhere we roam, the technological advances in long term care equipment provide residents and caregivers a safer, easier world.

Beds

The bed may no longer be where residents spend all their time, but for many of them remains the centerpiece of long term care equipment. That's why new designs may be as important as technological advances.

"If you walk into a resident room, it tends to be the largest piece of furniture in the room," says Jeffrey Hertz, president of Hertz Supply Co Inc. in Allentown, Pa. "Therefore, it tends to catch your eye. And when the bed really looks nice, it makes the room look nice."

Hertz says today's beds have a "less clinical look" and appear "more homelike" than those of yesteryear, and that does wonders for patients' psyche, for their dignity.

Of course, a new look just scratches the surface: Beds now provide more comfort than before, and other features make them safer and easier to use.

Among the most important changes: locking mechanisms to stop beds from moving, advanced spring systems to help with pressure problems, and the elimination or enclosure of the mechanics underneath. New materials, such as aluminum, have transformed construction, durability, load capacity and design.

In recognition of back stress ailments that are nearly epidemic among the industry's caregivers, bed manufacturers introduced high-low systems. The ability to raise a bed provides caregivers a work surface that lessens bending. And patients benefit from the ease of moving in and out of beds that can get low to the ground--in many cases, just 7 inches off the floor.

"Now, residents can adjust the beds themselves," Hertz says, adding that this frees up caregivers and therefore is "a big cost saving for the facility."

Hertz, whose company specializes in beds, believes the high-low movement is one of the two biggest changes he's seen to beds in recent years. The other is the adaptation of current side-rail recommendations, which the Maryland-based Hospital Bed Safety Workgroup has made to the U.S. Food and Drug Administration.

Chairs, too, have changed. As government officials restrict the number of hours a resident may remain in bed, notes Hertz, "seating becomes a challenge for nursing staffs." So chairs have evolved during the last 15 years to "become more functional," he says. "Improvements allow for the adjustment of extremities to meet any individual's requirements without getting a custom chair."

Lifts

Darlene Lauck has been in the industry for much longer than a quarter-century--36 years, in fact, as a CNA at Beverly Health Care Salem in Salem, S.D. And, for her, the biggest equipment changes have involved lifts, especially in the past five years, she says.

Of course, we are a far cry from days when, as Lauck notes, you needed "three or four people to lift someone out of bed" and heavy lifting often was a part of her daily routine. But these contraptions can appear a bit ominous. Residents are "not scared" of being raised into the air, says Lauck. "After the first time, they are real content to use them. They're not a bit afraid."

Lauck wonders, "How did we ever do it before? It's so much easier compared to what it used to be."

Well, lifts used to be hand cranks, chains and metal slings. Hydraulics improved things somewhat, but it was the electric actuator "that allowed one operator to work a lift," says Noel Duquette, vice president for sales and marketing for T.H.E. Medical of Longwood, Fla.

Until recently, lift evolution meant improved comfort. Nylon webbing, softer materials and padding replaced metal. Better casters and sturdier construction allow staff to move heavier patients--up to 1,000 pounds today.

But lift technology recently jumped, literally, right up to the roof. Ceiling lifts carry patients from one place to another on tracks mounted into the ceiling. "Lateral movement is now just as easy as up-down movement," says Duquette. But the biggest benefit: Ceiling lifts use zero floor space in an environment that never has enough.

Lift advancements also include a new generation of sit-to-stand lifts. Individuals with some abilities to move and bear weight use these devices to move easily--and independently--from standing to sitting. "Residents really like these," says Duquette. The health benefits are obvious too, since "they are participating in the transfer."

The sit-to-stand lift technology had an enormous impact on residents' psyches when it moved into the bathroom.

"Privacy has always been sacred to everyone," says Carmine Rossi, vice president of Clark Medical in Missauga, Ontario, Canada. "... It was demoralizing to many that they had to toilet with someone there."

Beginning in the late 1980s, sit-to-stand power lifts were adapted for toilet seats. "Power lifts gave people a tremendous advantage," says Rossi. "The key is being able to maintain independence."

Wheelchairs

Dale Nash minces no words in describing the evolution of the wheelchair. "The development has been huge over the past 10 years." But he's actually more excited over the acceptance into American society of another mobility device: the rollator.

"They are just now taking hold in the U.S.," says Nash, director of marketing for the Continuing Care Group of Invacare, based in Elyria, Ohio. "But they've had them for 10 years over in Europe."

A crossover product between a walker and a wheelchair, the rollator resembles a shopping cart. "It promotes proper gait training, and it doesn't send out that 'I'm an invalid' message," Nash says. "They're actually a bit racy looking. They give users a level of independence in terms of mobility, but you can also pop the seat down and take a breather when you need to."

Whatever inroads rollators eventually make, wheelchairs remain the most visible device for people requiring mobility assistance. Nash says improvements in their technology help every user including lighter-weight construction, motors that are able to bear more weight, stronger tires, better bearings and tracking over uneven surfaces.

And "the appearance of wheelchairs changed dramatically," says Nash. Lightweight and breathable fabrics such as nylon appeared, and new structural materials opened the way to colors other than chrome. "People weren't ashamed of the product they were in anymore," Nash says.

Paul Weinstein, president of Colonial Medical Assisted Devices in Nashua, N.H., notes that the simple low-rise seat cushion dramatically improved wheelchair-bound residents' lives. The cushions "bring users closer to the floor. Those inches allow them to push themselves around. Anytime you can keep someone moving, you've made their situation better."

And Lauck points out that with wheelchairs having high backs, residents can recline, lay in them and relax as never before.

Interestingly, consumers have also seen another benefit recently. Wheelchair costs have come down dramatically," says Joel Treffert, director of marketing for Direct Supply Equipment of Milwaukee. He notes that in the past two or three years, the price of an average chair has fallen 20 percent to 30 percent.

Of course, not all chairs are average. "There are wheelchairs today that will put a person in an upright position," says Weinstein, "and also climb stairs. Those are very expensive, true. But because of computers and improved technology, there isn't anything you can't get."

Bathing

The father of specialty equipment for the long term care industry is a man named Owen Berthelsen--so says John Brasch, president of Senior Technologies, a division of Stanley Security Systems in Lincoln, Neb.

Brasch credits Berthelsen, a former colleague, with inventing the modern sit bath system, which he designed specifically for nursing homes. It featured an electric hydraulic lift to get patients in and out of a tub, and then used a whirlpool to help them bathe.

"Beforehand, people were bathed either sitting in a shower or in an island tub," Brasch says. "People had to be [manually] lifted up into it. Nurses got wet, patients were at risk."

Today, dangers are significantly reduced for both parties. Side doors allow residents with some mobility to step into a tub. For everyone else, high-low capability allows a tub to be lowered for safer transfers. Once the resident is positioned, the mechanism raises the tub to a level that eases stress on the caregiver's back.

Even the water is improved. Facilities recognized that bacteria growing inside the whirlpool system's pipes were causing cross contamination. Tubs now disinfect themselves with the touch of a button.

In the past few years, "bubbler systems" have appeared as an alternative to whirlpool bathing. The tub produces bubbles of air that rub against the user; that friction assists cleaning. According to Hertz, bubbler systems are easier to disinfect, and they retain the hydro massage qualities of whirlpool systems.

Some debate the relative merits of whirlpool and bubbler baths. Duquette says bubblers are neither hydro massage nor therapeutic and doubts the tubs' resilience in the face of bacteria.

Hertz sees all bathing technology moving in two directions simultaneously. "One direction is to continue to sophisticate; the other is to simplify the process." Advanced technology continually adds new features, creating a more sophisticated product, Hertz says. Meanwhile, researchers work to reduce the cost of operating the system without reducing the features complexity and losing its benefit, Hertz says. The co-existence of the two paths "is really good," he suggests. "The customer gets a choice."

Tracking systems

In 1987 fall-prevention systems were born, spurred by the Omnibus Budget Reconciliation Act of 1987 (OBRA-87), which severely limited the use of restraints by nursing homes. An industry that routinely tied down its clients "is almost restraint free now," Colonial's Weinstein says.

The transformation, says Weinstein, was a low-tech triumph. Wedges, pads, gap guards, bolsters--"They aren't high-tech, [but they all] prevent people from getting out of their beds without the need to physically restrain them."

Two decades ago, residents were kept in a facility by locking the doors or strapping them down. That changed with the arrival of electronic anti-wandering devices in the mid-1980s.

Today's monitoring systems perform essentially the same task as the first-generation products, says Terri Volz, product manager for Senior Technologies. Residents considered to be at risk for wandering are outfitted with a bracelet, ankle strap or other device that can be detected by sensors positioned at each door of a facility. If the patient approaches the door, an alarm sounds.

But in the past decade, the biggest monitoring advancement has been "the addition of delayed egress locks, or specialty locks, that can be used with or without" anti-wandering equipment, says Senior Technologies' Brasch. These locks basically keep a door locked unless it is pushed on for three seconds based on someone trying to exit. And then it goes into alarm mode and unlocks some 15 seconds later. Alternatively, it unlocks if a fire alarm is pulled. "Basically it delays the exit of someone trying to get out that door."

IN THEIR WORDS

"Over the years, the steady stream of regulatory changes, such as MDS submission, PPS reimbursements, and now HIPAA, has served as a catalyst for LTC technology by motivating providers to invest in technology to automate the processes required for compliance. The success or failure of any technology company in this industry depends on whether they view these changes simply as problems to overcome or rather respond to them as opportunities to improve the way we care for our nation's elderly."

Todd Spence

President/CEO

MDI 

St. Louis, Mo.

"The use of software has become an integral part of the daily routine of an increasing number of staff to capture data and retrieve information for analysis. Cash flow is the most obvious example of an area that has improved through electronic billing. E-mail and the Internet have dramatically enhanced communication and timely distribution of information within the organization. Information technology has empowered decision-makers at all levels of the organization by providing information that is simultaneously more accurate and timely."

Doron H. Gutkind

CEO 

LINTECH

Ft. Lee, N.J.

"Over the past 25 years, the role and presence of occupational, speech and physical therapy has expanded in various environments including home health, assisted living and skilled nursing facilities. Recent emphasis has been on Wellness and holistic, individualized programs that promote functional independence, health, and quality of life. Seniors benefit from greater accessibility to the diverse services provided by skilled professionals who specialize in geriatric rehabilitation for seniors at all levels of health across the continuum of care."

Holly Spigner

Lead Clinical Specialist,

RehabWorks

Philadelphia, Penn.

"The emergence of the Internet has dramatically transformed the nursing facility selection process. Over a hundred thousand prospective residents, family members, and hospital discharge planners are researching facilities by entering 'Find a Nursing Home' in search engines every month. Web sites provide comprehensive data on nursing facility performance, quality and staffing levels. Nursing facilities are also embracing the web as a means to expound upon this performance data. Consumers then use this information to determine which facilities to visit and ultimately, to make their placement decision."

Bob Abrams

President

MyZiva

Lake Success, N.Y.

"Historically, the long term care industry has relied on antiquated information systems technology to assist in managing their business, with nothing distinguishing one system from another. This is because up until now, information systems have been designed to accomplish little more than meeting regulatory requirements. Today, industry leaders are facing significant new business problems--lawsuits are rampant, skilled labor is scarce, reimbursement issues are crippling, and quality of care is difficult to maintain. It's now time for those who provide information technology to step up and deliver solutions that address these major business issues with services that allow organizations to successfully meet the challenges. I am proud to be part of a company that has led the effort to raise the bar and is delivering the first system that will truly make a difference."

Larry Garatoni

CEO, Archieve Healthcare Technologies, Eden

Prairie, Minn.

"The recognized value of measuring and improving resident and family satisfaction has steadily increased the number of long term facilities listening to the voice of their patients through the use of satisfaction surveys. The Quality First Covenant has resulted in a commitment to improve quality using client."

Melvin F. Hall,

PhD

President/CEO,

Press Ganey

South Bend, Ind.

CHRONOLOG

Late 1960s The Sit Bath System is introduced

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1985 Anti-wandering equipment enters the market

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1987 The Omnibus Budget Reconciliation Act of 1987 (OBRA-87) is enacted, calling for a change in the way patients were restrained

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Late 1980s Sit-to-stand power lifts are adapted for toilet seats.

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Early 1990s Delayed egress locks are introduced

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Rollators are introduced in Europe

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1995 The FDA issues a safety alert, "Entrapment Hazards with Hospital Bed Side Rails." Since then, reports of death and injury to the FDA continue to document patient entrapment in side rails.

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1999 The FDA in partnership with representatives from the medical bed industry, national health care organizations, patient advocacy groups and other federal agencies (Health Care Finance Administration (HCFA); Consumer Product Safety Commission (CPSC), and the Veterans Administration), formed the Hospital Bed Safety Workgroup (HBSW). Its goal is to improve the safety of hospital beds for patients who are most vulnerable to the risk of side rail entrapment.

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