Communications breakthroughs in long-term care.

Why Captain Kirk and Dick Tracy must now share their technology with resident care staff

From Dick Tracy in the 1940s to Captain Kirk in the 25th century, the two-way wrist radio has been standard operating equipment. Now the communications technology of our imaginary worlds is becoming reality and, in fact, is just beginning to emerge in long-term care. Personal Communication Service (PCS) technology is opening up new possibilities for staff and resident communications.

PCS technology is, essentially, a digital network of communications services using lower power than cellular technology but with potentially wider service and greater clarity. Technically, it makes use of the 1.9 GHz radio spectrum made available recently by the Federal Communications Commission. When connected with a PBX, as in a nursing facility, this adaptation of PCS uses small, portable wireless phones permitting instant two-way communication throughout a facility and to the outside environment. This has opened up new possibilities not only in voice communication, but some degree of text transmission, e.g., e-mail or patient information. Because of these highly portable wireless devices - about the size of a cigarette pack - person-to-person communication is no longer restricted to fixed locations or convenient access to a phone.

The long-term care field raises several possibilities for this type of technology. For example, as nursing homes take on subacute care or manage frail residents of ever-increasing acuity, the ability of nursing staff or therapists to be contacted immediately at any location, directed to where they are needed and enabled to report to supervisors instantaneously becomes clinically important. Noisy overhead pages and rapid dashes to the nearest available phone (and lengthy waits for a response) become things of the past. PCS technology can also be connected with nurse call, giving the resident and staff instant voice communication.

In general, staff are freed up to move about the facility to perform resident care, rather than having to man desks and phones. Even the nurse call doesn't necessarily have to be routed through the nursing station. Some hospitals I have worked with employ a communications triage staff (or staffer) who can take the resident's call, determine the level of assistance needed (sometimes with the aid of a special computer program) and summon the appropriate staff to the scene. In fact, the nursing station doesn't even have to be occupied - an effective solution to the problem of that third-shift charge nurse who spends time waiting for something to happen.

The technology that makes this possible is not particularly difficult to install. Depending on the size of the facility and the number of wireless phones to be used, a number of "base stations" - small antennae - are installed in ceilings throughout the facility and connected with standard telephone wiring. Computer controlled, these antennae serve the same purpose as the communications towers used to "hand off" calls involving cellular telephones. It's just that, in this case, the "hand-offs" are grouped closer together. This proximity, combined with the digital technology used increasingly in PCS communications, eliminates the fading, popping and crackling customary with cellular phones. Also, using relatively low power, they avoid the interference problems with electronic equipment that has resulted in cellular phones being banned from many health care facilities. PCSs also avoid the security problems of cellular phones, which are susceptible to break-ins by any dedicated hacker interested in eavesdropping.

For a 100-bed facility using, say, seven to ten phones, installation of the antennae, phones and PBX connections would cost approximately $30-40,000. Several traditional PBX system providers, e.g., Lucent and Fujitsu, are developing wireless applications that are attached to the PBX for two-way communications encompassing hundreds of thousands and even millions of square feet. The next step is to find a PCS provider who can help make the facility's internal communications system compatible with the outside network to allow calls throughout the vicinity. This is obviously not a requirement now, but may become more attractive as the external PCS infrastructure is completed.

A bit more about those interference concerns, expressed often and regularly by hospitals with their multitude of high-tech devices, and which could conceivably be shared by nursing homes moving into more technology-rich subacute care. No doubt these concerns arise from past experiences with cellular phones, which have been known to shut down crucial monitoring and diagnostic devices. With PCS, though, these concerns are minimal to non-existent, at least with more modern equipment. Vendors will in any case run on-site tests to make sure there are no problems.

Overall cost-benefit analysis of a PCS system for a nursing home would revolve around several factors: the importance to the facility of having instantaneous two-way communication with staff on the floor and outside the facility; the possibility of having more efficient utilization of staff who are not tied to desks or nursing stations monitoring calls; the peace and quiet from the elimination of over-head pagers; the attractiveness of new options becoming available for reading messages; and the relative clarity and security voice transmissions as compared with cellular phone technology. All of these have to be weighed, as usual, within the limits of the facility's mission and budget. It seems a certainty, though, that more and more long-term care facilities will find themselves entering the 21st century using communications technology that Captain Kirk would approve of.

RELATED ARTICLE: New Use for Old Phones

Like used cars, used phone systems can provide years of ongoing service at considerably reduced costs. What's more, the old systems can be adapted to the specific needs of residents of nursing homes and assisted living. Residents can call one another at no charge, using a simple four-digit number. Voice mail can be provided that works much better and more conveniently than individual answering machines. Quick dial can be set up connecting residents with their physicians or with friends or family in the community at the push of a key, without their having to remember specific phone numbers. Arrangements can be made with outside carriers for special reduced rates. In short, there is "life" in those old systems and real possibilities for long-term care providers to offer an attractive communications option.

Timothy Taft has had 14 years of telecommunications consultation experience and is associated with McGladery & Pullen, a large accounting and consulting firm based in Schaumburg, IL. For further information, [phone].