Departure alert comes to assisted living.

Departure alert identification systems used by assisted living facilities combine doorway access-control devices with monitoring of residents who tend to wander. What makes the devices used in an assisted living facility different from those typically employed by nursing homes is an emphasis on unobtrusiveness. The idea of a "residence" must be maintained. To that end, the devices are usually silent.

According to Bob Liethen, manager of the LTC group for Code Alert, Brookfield, WI, the access-control monitor traditionally used in nursing homes sets off alarms when residents approach certain doors. In assisted living facilities, these can now be programmed to lock the door in question rather than sound an alarm, allowing for a an equally safe, yet more pleasant, environment.

Today, he adds, these departure alert devices, such as Code Alert's Quick Response System, (QRS) are used to augment an assisted living facility's traditional wireless system, in which residents wear a radio frequency (RF) transmitter around their necks that they can touch to alert someone if they are in need of immediate help. Code Alert's QRS communicates with a central Windows-95-programmed computer via radio frequency to let caregivers know the resident's exact location so that they can administer help in person. The computer system is backed up so that the device continues work in case of a crash.

The QRS can also be integrated with pullcords, smoke alarms and other safety devices, says Liethen, creating a total solution that offers assisted living facility residents maximum protection. The company is already working on future products that would add two-way communication in addition to the voice-to-voice communicators they already offer.

Says Mike McKerley, national sales trainer at Secure Care Products in Concord, NH, the growth of the Alzheimer's population residing in assisted living facilities is indeed changing things. Facilities where Alzheimer's residents are segregated from other residents need to use selective monitoring and access control to keep the Alzheimer's residents in their part of the building. Those who wander into other parts of the building tend to get confused - because there are just too many doors - and other residents don't want them roaming in their private areas; so these devices "keep the peace."

Secure Care has actually run its own assisted living facilities, says McKerley, and its products have proven to work well in this setting. People in assisted living facilities are basically independent, he says, meaning that restricting traffic flow in high-traffic areas by locking doors is not recommended. Secure Care's wandering control devices include the Advantage 1000 DE delayed-egress system that is unlocked for normal traffic flow, locks when a wandering resident approaches, then unlocks again when he or she leaves the area. Even though no alarm sounds, personnel can be notified, because the device can be directly interfaced to magnetic locks, cameras, nurse stations, pagers and a wide variety of other monitoring equipment. They can also be tied in to printers for the creation of a printed record of events.

The Advantage 1000 DE can also be used for perimeter access control by locking doors during preprogrammed hours and signaling if unauthorized exit or entry occurs. In case of emergencies, the control panel can be tied in to the fire alarm, to allow the doors to open.

Another important consideration, says McKerley, is that these devices are low-profile. Secure Care's systems are flush-mounted, and the stainless steel faceplate can be painted to match the walls. Secure Care's devices are programmed through the keypad, so there's no need to remove them to recode. And because they must operate around the clock, there is no way to disarm them. They also have a battery backup in case of failure, as well as an anti-tailgate feature - i.e., once a staff member goes through a door, the device resets itself so that a resident can't follow behind, and outsiders can't use the opportunity to enter.

There is a role, says Charlie Barr, accounts manager at Care Technologies of Atlanta, for alert systems at all levels of the continuing care residential spectrum, be it skilled nursing, assisted living or even an independent living facility. A coordinating computer for a CCRC can be kept at the location offering the highest level of care, Barr notes. Care Technologies' CommunityCare computer-based system is comprehensive yet modular, so any kind of caregiving facility can adapt its components for monitoring its particular residents.

The company strives to take the "institutionality" out of its systems. All of its alert and response mechanisms use unobtrusive RF communication. All signals can be directed to Motorola beepers so that caregivers need not be tied to a console, and alerts are noiseless, so as not to disturb the residential feeling of the assisted living environment. Remote signalling has opened such possibilities, says Barr, that the American Institute of Architects has decided that skilled nursing facilities with pagers need no longer use dome lights to signal caregivers.

The CommunityCare system offers many linkages, including the ability to monitor smoke detectors in resident apartments, enabling caregivers to move residents quickly in case of fire. Other linkages to pullcords include a component in which caregivers must hit a button to record the time of their response to a resident's calls. Barr recommends waiting until residents move in before installing pullcords, to give them a better sense of control by inviting their input regarding placement of the cords. He also notes that this is a good marketing tool, because it lets prospective residents know their needs are paramount.

For dementia patients, who tend to abuse pullcords, Care Technologies offers alert-response buttons inside the door of a room, so that caregiver rounds can be monitored and the caregivers doing regular checkups can quickly signal for help.

Residents can carry personal emergency transmitters wherever they are to summon help, another option that residents deem important, especially in independent and assisted living settings, says Barr.

Very importantly, all alerts and responses are logged on the CommunityCare system, so that there is a permanent record of what happened, where and when. This reduces uncertainty about the causes of slow response time; directors are able to see how the staff is responding to resident calls. In addition, function keys can be programmed to allow the central computer to perform simulated alerts which, among other things, can be used as a marketing tool to show families how the facility is prepared to deal with emergencies.