Communication unlimited.

To communicate, with someone, you've got to find them first. In today s busy, complex, sometimes far-flung world of business, usually the best we can do is signal our desire to communicate with someone - the answering machine, e-mail or, in the nursing home, sounding an annunciator alarm or blaring out the party's name over the public address system. "Communication," though, it isn't - at least, not until someone notices you're asking for them.

Modern technology is beginning to change all that. All types of direct communication - resident-to-staff, staff-to-resident, staff-to-staff - is becoming possible, no matter where in the facility people happen to be at the time, using equipment no more conspicuous than Dick Tracy's fabled two-way wrist radio. It is also possible to know where a resident, a staffer or even a much-needed piece of equipment is located at any given time in the facility using Space-Age-sounding infrared signaling.

Some of the new communications equipment is just beginning to penetrate the long-term care market. Some of it has yet even to hit the market, but is expected momentarily. based on the premise that it is always good for facility management to be prepared for future decision making, here's a sampling of what appears to be in store:

Dukane, marketer of the computerized nurse call systems ProCare 2600 and ProCare 6000, and Nortel, marketer of the wireless telephone called Companion, have combined forces to integrate the two products into a direct nurse call system. The computer routes a resident's call (for example) to a wireless phone carried by the nurse. The phone chirps or buzzes and the nurse sees, via an LCD display on the phone, the resident's room number and priority of the call and, at the push of a button, communicates directly with the resident via a pillow speaker. The nurse is also reachable in this manner by other staff who need assistance or consultation. Though the product is designed primarily for the hospital market (see "Special Product Focus" for Dukane's more long-term-care-oriented product), there are obvious possibilities for long-term care facilities willing to make the investment, particularly those with post-acute care units.

Even more chronically oriented and less well-capitalized facilities may want to "test-drive" some of this equipment, though, according to Tom Ohlsson, marketing director for SpectraLink, developer of wireless communications for hospitals and long-term care facilities. "Though many long-term care facilities don't have the capital budgets for this sort of thing," he says, "I can see several reasons why their interest might grow."

For one thing, costs of some of the basic equipment are starting to decline. Case in point: SpectraLink's base stations (the "antennae" for wireless) have increased in sensitivity, says Ohlsson, to the point that fewer installations are needed. "If you went from 10 of these to 6 of these, you could save around $3,500 in equipment costs and $400 to 800 in installation," he notes.

Second, thanks to computerization, facilities can program their own communications applications - in SpectraLink's case, through the use of its Open Architecture Integration system and software tool kit.

Finally, the advantages of integrated nurse call/wireless phone systems (SpectraLink is working with Dukane on one, as well) are becoming more apparent to nursing homes - e.g., relief from the noise of overhead public address systems and buzzing annunciators, and the ability of busy staff to triage resident calls ("Wait a minute; it's that chronic complainer in 201 again").

There's yet another new technology that not only allows parties to directly communicate, but displays where they're communicating from anywhere in the facility: the Nightingale Resource Management System from Versus Technology. (Their product has even inspired Microsoft magnate Bill Gates to install it in his palatial Seattle mansion.) In the nursing home, the resident wears a lightweight badge emitting an infrared signal pinpointing his/her location and, if so programmed, interacting with doorlocks to either permit or deny egress. A special add-on permits two-way communication between resident and caregiver, whatever their respective locations. What's more, a record of the resident's "travels" can be stored and displayed as a pie chart showing what percentage of time the resident has spent at various locations (room, cafeteria, day room, activities, physical therapy, etc.) during a given day.

In sum, if (like Greta Garbo) you "want to be alone," that's starting to get a bit difficult. On the other hand, in the intense and needy environment of a healthcare facility, where direct communication is at a premium, maybe the future can't come quite fast enough.

For a look at further new technology in this field, see the Special Product Focus, p. 67.

Richard L. Peck is Editor of Nursing Homes/Long Term Care Management.