Evaluating technological innovations for assisted living: an interview with gerontologist and medical sociologist Rebecca A. Meehan, PhD.

Resident monitoring technologies in long-term care need human assessment. While these innovations may supplement personal care, their effects on staff, residents, and families must be measured. One of the researchers gauging the sociological impact of resident monitoring systems is Rebecca A. Meehan, PhD, a gerontologist and medical sociologist, and a senior research associate at Case Western Reserve University in Cleveland. Her consulting firm, the Meehan Group, LLC, focuses on healthcare research and long-term care technology research.

Dr. Meehan has been involved in healthcare and long-term care research for nearly 15 years, conducting a mix of applied and academic research. She is a member of the Center for Aging Services Technologies (CAST), has served on AAHSA's Institute for the Future of Aging Services (IFAS) national research task force, and has been a part of the White House Conference on Aging. She has worked (and continues to work) with architect and gerontologist Margaret P. Calkins, PhD, at I.D.E.A.S., Inc. (Innovative Designs in Environments for an Aging Society). Dr. Meehan also spent time at the Myers Research Institute in Beachwood, Ohio, conducting applied research directly with staff and residents at the Menorah Park Center for Senior Living. "At both I.D.E.A.S. and the Myers Research Institute, we focused on improving quality of life and quality of care that seniors experience today rather than next year or some time in the nebulous future," she says.

In 2001 and 2004, Dr. Meehan assessed the sociological impacts and cost benefits of the Vigil Dementia System, a resident monitoring technology used in environments for people with dementia. Her research found that

facilities using the system from Vigil Health Solutions, Inc., achieved high occupancy rates faster than the national norm for assisted living facilities, maintained high occupancy rates more consistently than the norm, and had the potential for reducing staff. She discussed her findings in terms of the broader technological implications in an interview with Nursing Homes/Long Term Care Management.

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What was your role in this study?

Dr. Meehan: In 2001, I did an evaluation with Vigil when I was at the Myers Research Institute, and in 2004 the Meehan Group did another. Vigil wanted to assess the effectiveness of its product. I looked at this sociologically; I did an assessment by talking with staff and family members of people who were using this system. I spent time in the Ohio facilities using the Vigil Dementia System. Additionally, myself and a business professor colleague conducted a return on investment (ROI) analysis.

How does this technology work?

Dr. Meehan: Essentially, it's a motion-sensor system based in a resident's room. My assessments were made on single-occupancy rooms (although the technology is available for use in shared rooms). It is not a camera, which is important, because it maintains a person's privacy. The system is set up in different parts of the room, and it can be tailored to each resident. There's a sensor in the middle of the room, one on the bed, one at the threshold of the unit's door, and one on the bathroom door. The system allows residents suffering from dementia a means of summoning help without being cognitively alert. Each resident can have unique settings as to what is acceptable or unacceptable movement in the room. For example, if a resident is at risk for falling and has a difficult time getting to the toilet at night, a setting would send a signal to a nurse if the resident gets out of bed. Parameters (all set up on a computer program at the central nurses' station) could also include signaling a nurse if the bed is wet from incontinence.

Staff are alerted by a vibrating pager or a wireless phone system, depending on how the facility has it set up. There's no alarm bell that rings and no flashing lights, so it really decreases agitation in residents. It's a discreet and sensitive way of letting staff have the best information about the person who needs their help. Staff have to flip a cancel switch when they come into the resident's room, letting the computer system know that the concern has been addressed.

How did your background fit into these studies?

Dr. Meehan: An academic research background and an applied research background sometimes have a hard time coming together. You want to use an effective methodology for assessing a new technology like this. You want to know if staff members can use a new technology. You identify problems and weigh the pros and cons of a new technology--what's working and what's not working. Also, consider the families and the residents themselves--how are they faring? That's what helped make this work--by talking to all of the players, so to speak: talking with the staff, talking with family, and talking about the residents.

What were your goals for these assessments?

Dr. Meehan: In the first evaluation in 2001, we talked to staff and observed their productivity, as well as resident care. The goal was to find out what was working and what was not working with the system in regard to staff productivity and the resident care that they ultimately gave. In the second assessment in 2004, the goal was a cost-benefit analysis, looking more rigorously at the financial aspects of whether the system made financial sense for the investment. A colleague looked at the numbers on that, and he did an ROI analysis. There are a number of different goals for the system. Some of them are the end-user goals, regarding staff and resident care, and others are managerial goals, in terms of the ROI and whether the system is worth the expenditure.

How did you measure sociological aspects?

Dr. Meehan: In the first study, we had a semi-structured interview with staff members about the pros and cons of the system. Staff were telling us, for example, that occasionally there would be a false alarm--again not an audible alarm, but a false signal--that went to the pager. We made sure to let the company know about that. We also emphasized, in terms of the sociology of the system, that anyone has a learning curve using new technology. It's hard to learn something new, especially when you've been doing something a certain way for a long time, which a lot of long-term care staff get into. We all get into a pattern. Introducing a new technology like this was a challenge; however, in the majority of these facilities, it was received well and they continue to use it today.

What did the cost-benefit analysis show?

Dr. Meehan: In our second study, in which we looked at ROI, we reviewed the statistics kept by the facilities. We talked with management at the sites to measure occupancy rates and fill rates when trying to fill a dementia unit at a brand-new facility. Those bits of data are the foundation for the ROI analysis. With this system, we demonstrated that these sites were achieving full occupancy faster than the national norm for other assisted living facilities. They not only filled faster, but they maintained a high occupancy more consistently. All of that lends itself to consistent revenue, contributing to a stronger ROI.

Sites estimate that they could reduce staff by a half full-time person per shift. In terms of staff productivity, they felt the staff could spend more meaningful time with residents, as opposed to exclusively conducting staff rounds to check on residents. They still have staff rounds, but they also can address other meaningful concerns.

We talked to insurance companies and facility litigation departments. Insurance companies, in fall 2004, were projecting a credit and reduced premium, within the next four years, for long-term care centers that were using this system because they, too, saw that this was going to help overall with injuries and with issues that affected insurance payouts.

While the system we examined does not prevent falls, our interviews showed that staff were able to get to residents faster if they did fall. This is important, as it helps to prevent secondary injuries (e.g. trying to get up and falling again, or throwing an embolism from lying on the floor too long), which often can be more injurious to a resident.

What feedback did you offer the system's manufacturer?

Dr. Meehan: Some of the feedback was in making sure the manufacturer had continued, good communication with staff members. You want staff members to feel comfortable using technology; if they don't feel comfortable, their residents won't feel comfortable.

I've talked to a lot of people in long-term care through my experience with consulting and research. Many long-term care centers do not have the money to build a brand-new facility from the ground up. More than likely, an existing facility with a small budget has to be able to offer the best quality of care for persons with dementia and provide the best quality of life. The question is, what can we do for these existing facilities? The good news is that the company is creating a wireless dementia system that will enable them to retrofit older facilities with this technology; it's about 12 months away from market.

What would you like to see developed in resident monitoring technology?

Dr. Meehan: I'd like to see a version of this available in personal residences. That's a little far off. Realistically, you have to consider the wide range of options when it comes to where people live--the diversity of our home structures and the people with whom we live. I've seen this technology in assisted living, but I'd like to see nursing homes, particularly those that care for persons with dementia, focus on bringing in new technology of this kind. I'd also like to look at some of the ROI for nursing homes from this kind of technology.

However, technology does not replace a human being--you cannot replace a human being with a technological monitoring system. Technology has to work hand in hand with the personal care we give others. That is the model we should all be working toward.

For more information, contact Rebecca A. Meehan, PhD, at the Meehan Group, LLC, [phone]. To send your comments to the editors, e-mail [e-mail].