Connecting: Residents meet computers. (Not-for-Profit Report).

Providing computer access for residents, once considered new and innovative, is fast becoming a routine part of LTC programming. In this month's Not-for-Profit Report, two very different facilities--a large, multi-campus CCRC and a small, county-owned nursing home--share tips for putting your resources to work to create a program that meets the unique needs of your facility and its residents. Whether simple or ultrasophisticated, computer-related activities can enrich your residents' lives.

Computers: Part of Life at Presbyterian Homes

If you put in computers, will they come? Presbyterian Homes in Evanston, Illinois, thought so. But a few years and several computers later, they're eager to share some well-learned lessons with other long-term care providers.

"We started with a typical technical approach, thinking if we held some classes and placed computers in labs, the residents would use them," says Jane Grad, VP of Information Management at the multicampus CCRC. But after several years, only a few residents, most of whom were already familiar with computers, were actually using the equipment. Without a sustainable program and proper funding, that equipment rapidly became obsolete, and new programs were not being introduced. Something was missing.

That something, says Grad, was an infrastructure to support this program. A new approach was adopted, and Presbyterian Homes' resident computer services have been thriving and evolving ever since. Building the needed infrastructure is an ongoing process, Grad explains, which involves providing residents with a variety of ways to learn, making computers easily accessible and establishing a funding source for needed upgrades and support materials.

Implementation of the new program began on the Evanston campus (one of nine Presbyterian Homes campuses), with its 390 IL and AL residents. In less than one year, 300 of those residents had been trained to use computers or Internet devices which consist of only a keyboard and screen but allow residents to send and receive e-mail and access the Internet. Similar services were then rolled out to other campuses.

Monthly workshops complement the classroom training by providing practical uses for the computer and the Internet. In addition to classes and workshops, lectures and discussions are held to address such topics as how to buy a computer.

Grad points out that Internet devices are a perfect option for residents who are intimidated by the prospect of using a computer.

"It's also an excellent entree into using a computer, if that's what residents want," she explains. She adds that it takes only one or two half-hour sessions to learn how to use the devices; a part-time staff member provides the one-on-one training.

Three Internet devices have been placed in each of Presbyterian Homes' larger facilities, and one in each of the smaller facilities. Each resident has his or her own e-mail account, through MSN Hotmail, and can access it from any on- or off-campus Internet device or computer. The devices are available for use around the clock.

The three largest campuses also have resident computer labs where residents can take classes or participate in "open time," during which they can sharpen their skills, get one-on-one technical support or just spend time on the Internet or work on projects such as greeting cards. Employees are not permitted to use the computer lab. When classes aren't in session, however, residents' family members can use the lab computers.

One key to starting an effective computer program, says Grad, is to begin slowly and let residents create the demand. "We began by purchasing the Internet devices, at only $99 per unit (with rebates)," she says. "Once the demand became apparent, we moved on to renovating the training labs."

To make the equipment as user-friendly as possible, the size of the icons was increased and the cursors slowed down. Each lab has one computer with an easy-to-manipulate roller-ball mouse. The Internet devices can use a standard mouse or a push-button device. Recently, keyboards with large keys and programs to magnify what is presented on the monitor were introduced for sight-impaired residents.

Grad stresses the importance of monitoring the program and documenting its progress. "I keep statistics in a variety of areas, tracking all of the people who have attended seminars, workshops and classes, keeping track of how often they return and sending residents e-mail just to see if they're still using their accounts." Those statistics speak volumes; of the 525 people who were trained to use the computers or Internet devices, more than 75% are still using the equipment today. "Once we get them," says Grad, "we don't lose them. Residents who master a skill invariably want to learn more."

These statistics enable Grad to show Presbyterian Homes management how far the program has come, and how great the demand is. "It's important that we're able to demonstrate that this is a viable activity," she says. The statistics have also shown that family members are very interested in using email as another way to stay in touch with residents.

Grad emphasizes the importance of treating the computer program as an activity, rather than a technology, to generate and maintain interest. To that end, schedules and events are employed as they are in other activities. For example, last June residents participated in Family History Month by attending special workshops and typing their memoirs. During National E-mail Week, the focus was on giving out buttons and signing up new participants. At Christmastime, special workshops were held to make cards and family letters.

Grad is also working on plans to include more Presbyterian Homes residents in computer-related activities. "I'd like to encourage more of our assisted living residents to participate, and I'm looking at ways to use the computer program to enhance the lives of our skilled nursing residents; a voice-recognition program is being considered as one means of achieving that goal."

Grad notes that, because the computers and Internet devices are so enjoyable, finding staff to help out hasn't been a problem. When it comes to formal assistance, however, she is careful not to commingle the corporate and resident-related duties in her department. "Staff members who work on corporate information systems do not work on the resident programs, and vice versa," she explains. Two part-time staff members work exclusively with the resident computer program, along with Grad.

It is the philosophy of Presbyterian Homes President and CEO Peter S. Mulvey that drives the thriving computer program at Presbyterian Homes. "He feels strongly that people who come into our community use computer technology as they use televisions, phones and other devices that have become part of daily life," says Grad. "Computer use has become a baseline service." In keeping with this philosophy, there is no charge to the residents for computer classes, services or supplies.

The benefits of the computer program are numerous, says Grad. "Residents get a sense of accomplishment from mastering a new skill, and rather than feeling 'left behind,' they are connecting with family and friends, and to world and national events."

One resident used the computer lab to access the Napster Web site after she'd read about the controversy surrounding it. "At one time, that newspaper article would have meant nothing to her," Grad says. "Today, however, she's 'in the know' about topics and issues that might otherwise have passed her by." Another resident has used the Internet to research information for a presentation to other residents about current events.

Grad notes that this sense of connection is especially important for long-time Presbyterian Homes residents, and it is strongest as it relates to family. "E-mails and photos sent to and from children and grandchildren really do energize our residents." This is true even of a 102-year-old woman who corresponds with family from outside the United States.

There is little doubt that the residents of Presbyterian Homes will find new and exciting ways to stay "connected" as the computer program grows and evolves.

For more information, call Jane Grad at [phone] or e-mail [e-mail].

RELATED ARTICLE: Monopoly Anyone?

At Steuben County Health Care Facility, a municipal, county-owned, 105-bed SNF in rural Bath, New York, computers are adding a new dimension to residents' quality of life.

It all began with one long-time, wheel-chair-bound resident, explains Assistant Administrator Diane Krans. "He is a young man (under age 50), and we're always looking for new ways to enrich his life." When the resident expressed an interest in computer games, an older computer that had been "retired" from the facility's office was placed in the solarium at the end of his unit. Because he can use his hands but not his fingers, a special roller-ball mouse was placed at the computer station. Video and audio components were added, and the standard Microsoft games that were already on the system provided hours of enjoyment nearly every day.

Soon an 80-year-old gentleman, who had never even touched a computer, became interested in what his younger friend was doing. A second "recycled" computer was placed alongside the first, and the younger resident gladly served as an informal tutor. "As demand increased, we purchased three more computers, keyboards, mouses and towers, with the video and audio components," says Krans. Because the purchases were made via the New York State Office of General Services bid process, the facility was able to buy the three new computers for $680 each, with funds from its computer budget. New monitors weren't needed because the facility had several that weren't being used. The computers were placed in the common areas to make them as accessible as possible.

Today, about 15% of the residents use the computers, and some, every day. Training has been informal, with activity aides and other computer-savvy staff offering assistance and residents helping one another. "If I see a group of family members sitting in a resident's room having what appears to be a one-sided conversation, I'll take one of them aside and show them how to use the computer. That family member teaches the others, including the resident, and the family then has an activity they can enjoy together," says Krans, who adds that the computer games encourage more frequent, and longer, visits, especially by younger family members.

"Starting a computer program like ours is not expensive, even if you buy new computers and components," says Krans. "You don't need word processing capabilities to play games; all you need is an operating system and the software." Krans adds that a printer is a useful, inexpensive addition and notes that programs, such as drawing packages for residents who are artistically inclined, can be added one at a time, as the budget permits. Even so, expenses can add up, and creative solutions are sometimes needed, as Krans found out when the original computer-game player had mastered, and become bored with, all of the Microsoft games. "Requests started to come in for games that would have to be purchased," she explains, "especially games that could be played with family members."

Krans searched the Internet to contact Hasbro, the manufacturer of many of the games residents were requesting. Once she found Hasbro's contact information, she sent Hasbro a letter describing the facility, its wish list and how the games would be used. It was then she learned the first commandment of donation procurement: Thou shalt go to the right person. "After I sent the letter, I received a reply, telling me that I had contacted the wrong department, and that I needed to send the letter to Hasbro's charitable trust foundation." She notes that Web sites for many large companies have a link for organizations requesting donations. "Look for the words 'donations,' 'community service,' 'charitable trust,' etc.," she advises. If you can't find such links, call and ask whom to contact about donations.

Once Krans had contacted the appropriate Hasbro division, it went more easily than she'd expected. Although its charitable trust was set up primarily to assist children, Hasbro was glad to help and sent 10 games in a matter of weeks.

As delighted as the residents were with the donations, a problem arose: The 10 games could be only played with the CDs inserted, rather than loading them onto the computers. So after one year (the time Hasbro requires between requests for donations), Krans sent in a second request and explained the problem. The company promptly responded with five copies of five games.

Today, two-and-a-half years after the first computer was installed, Steuben residents are enjoying computer games such as Monopoly, Scrabble, Life and Trivial Pursuit. There have been many benefits, including an increase in independence and autonomy. "Many of our residents like to play cards, but hearing and visual impairments, and varying attention spans, can make this a difficult group activity," Krans says. "Playing cards on the computer allows our residents to bypass those problems." One resident who had never even seen a computer, and who doesn't care for group activities, is now content to sit and play Solitaire for hours. An added benefit is how the computers have helped staff to get to know the residents in new and interesting ways. "I was surprised to see a particular resident playing computer games; it never occurred to me that he'd be interested," Krans recalls. "He told me that he'd been a pilot--something I hadn't known-- and that the games gave him the sense of 'being at the controls' once more .

Because of the age of the building and the remote location of the computers, only one of the computers is connected to the Internet. Some residents do, however, send and receive e-mail via Krans, and the facility's Web site (www.schcf.org) provides communityoutreach. Resident photos and monthly activities calendars are posted, along with the residents' rights and the facility's "Mission, Vision and Philosophy" statement.

If the building is remodeled or rebuilt, Internet access will definitely be a priority, says Krans, who notes that their three new computers can be upgraded. A full-time information technology staff member and an in-house computer consultant advise her on such matters. Krans is also considering the pros and cons of starting a computer club, in which students would meet at the facility and help teach residents about computer use.

Krans notes the importance of dealing with potential problems even before they arise. To be sure that the computers are used only by the residents and their families, the games are turned on at 5:00 a.m., by a staff member with a password, and turned off at 11:30 p.m. "It's also important to consider factors such as vision and dexterity when selecting games, Krans says. "Games like Solitaire are good choices, since they can be played at a resident's own speed, and games with different levels accommodate a wide variety of capabilities." It's also important that someone be available to troubleshoot at all times. Krans says that when something goes wrong with one of the computers, the residents want it fixed yesterday. "Once a program is up and running, computer use quickly becomes a basic need," she says.

For more information, call Diane Krans at [phone] or e-mail [e-mail].