Improving patient care.

Technology can better the lives of residents and staff

IT'S A TYPICAL DAY AT BEECHWOOD HOME, A not-for-profit skilled nursing facility in Cincinnati, Ohio. Residents are busy going about their daily routines: exercising, lifting weights, communicating via e-mail with friends and family, designing greeting cards, composing and playing music. What isn't typical, however, is that most of these residents have cerebral palsy, spinal chord injury, brain trauma, or other diagnoses that would prevent them from doing these sorts of activities without the help of assistive technologies.

Norman Haverkos, a 68-year-old resident at Beechwood, has watched 35 years of multiple sclerosis slowly rob him of nearly all muscle movement. But today, with the use of a wireless, tongue-touch keypad mounted on a retainer in the roof of his mouth, Haverkos can e-mail his son in Chicago, drive his wheelchair, dial the telephone, and operate electrical appliances in his room. In other words, he is able to regain vital areas of independence that MS stole from him.

Seniors in cyberspace

According to a recent survey by AARP, seniors are the fastest-growing segment of Internet visitor. What's more, SeniorCom, one of the Internet's most active senior web sites, claims that "seniors are the fastest growing sector in the PC purchasing market."

But long term care has been slow to capitalize on the trend. A survey of Wisconsin providers conducted by OMNNI Associates, an Appleton, Wisconsin-based architecture, engineering, and environmental firm, found that while 70 percent of respondents said they were online, only 5 percent said their residents were wired.

Why the low numbers? Catherine Donker, marketing director at OMNNI, says most providers are preoccupied with other concerns. "They see the need, but it's on the back burner right now," she says.

But in facilities that manage to make computers available to residents, the payoff is high. Here is a sample of the life-enhancing computer and Internet activities residents are logging onto:

* Hobbies and clubs. At Indian River West, an ACTS Retirement-Life Community facility in Vero Beach, Pennsylvania, residents of a newly formed book club use the Internet to locate information about books they might want to read.

* Staying in touch with family members. Not only do residents find computers and the Internet rewarding, providers have come to appreciate what a selling point they can be. "When we tell prospective residents about our Internet capabilities, they love the idea that they can e-mail their families," says Brisgill of Merrill Gardens. "Their families--many of whom are already online--love it too. And residents can do it without running up their phone bills. They especially love that!"

Being computer-literate can also help bridge the generation gap between residents and their families. "Residents feel it is a way of having something in common with their children and grandchildren." says Brown.

* Community connections. Connecting residents via the Internet with people outside of the facility is a goal of Merrill Gardens, an independent and assisted living community in Esplanade, Texas. Residents have started a pen pal program with residents of a sister facility in Orange City, Florida. General Manager Peggy Brisgill says the facility recently hired a volunteer to develop a similar program with the local high school.

At Gwynedd Estates, another ACTS facility in Lower Gwynedd, Pennsylvania, 30 members of a local high school computer club called Interact have volunteered their time on Saturdays to train residents on general computer skills, e-mail, and the Internet. According to Jane Dougherty, spokesperson for West Point, Pennsylvania-based ACTS, the students and residents have established close ties. "One student even brought in a cake for all to share."

At Plainfield Tower West, a 154-unit independent living community in Plainfield, New Jersey, residents use a computer encyclopedia program to tutor, on a weekly basis, grade-schoolers from nearby Milestone Preparatory Academy. Residents assist the students in researching topics for history papers and other school assignments.

* Fun and games. Residents of Plainfield Tower West also like to play solitaire and other games on the computer. And Beechwood uses computer programs in its occupational therapy, music therapy, and activity programs. An interactive music program, for example, allows residents to listen to various types of music, learn music theory, and try their hands at composing a song--or a symphony.

* Expertise. Because it operates on a tight budget, Plainfield Tower got a grant to fund a computer-training course taught by a visiting instructor. The instructor taught four residents who, in turn, teach the rest of the community. As it turned out, the residents enjoyed teaching others almost as much as they enjoyed using the computer themselves, says Sandra Brown, corporate communications director for Plainfield Tower West's parent, Princeton, New Jersey-based Presbyterian Homes and Services. "The residents love learning it because they can acquire new skills and teach them to other residents."

But getting long term care residents online involves more than just providing computers and training. Frustration in manipulating a computer could dampen the enthusiasm of even the most ardent computer user. People with arthritis, poor eyesight, and diseases or nerve damage that make muscle control difficult are especially prone to discouragement.

A number of inexpensive devices, such as oversized keyboards, monitors, and tracking balls, can make the going easier. Other assistive technologies include "adaptive pointers" that fit on residents' hands, allowing them to key in letters on the keyboard. And for people who can't use their hands, there's a light-emitting headband called a "head mouse" that can manipulate the computer screen much like a hand-operated mouse does. Head mice enable Beechwood residents to play games, send e-mails, explore a variety of computer programs, and surf the Internet. Used in combination with a voice-simulator, they can enable residents who are unable to speak to use the telephone and communicate verbally with staff and fellow residents. "These devices are not luxuries," says Kay Barker, an occupational therapist at Beechwood. "Our outcomes have shown enhancements in psychological as well as physical well being. We're getting closer to showing that they are a medical necessity."

Improving care quality

Technology can also help improve quality of care and quality of life for long term care residents in a number of ways, including the following:

* Encouraging exercise. Preventive care through regular exercise mean healthier seniors--and a healthier bottom line for your facility. And thanks to recently developed geriatric exercise equipment, age is no longer a barrier to exercise or strength training.

GreenTree Health and Rehabilitation, a 65-bed, skilled nursing facility in Clintonville, Wisconsin, recently established a rehabilitation and preventive exercise program called Physio-Fit, which uses a variety of geriatric-designed exercise and weight-lifting equipment. GreenTree, which is part of Mariner Post-Acute Network, has a weight station, leg press, and cardiovascular equipment such as stationary bikes and treadmills--all customized for the less mobile person. Features include equipment to strengthen the lower back, a key area of weakness for seniors; large, adjustable, cushioned seats; seat belts; and weight sets that are adjustable, in small increments, up to 300 lbs.

Exercise and weight training isn't just for the ambulatory. "The status of one's mobility doesn't eliminate the desire or need to exercise," says Diane Lee, therapy director for Beechwood, which has quadrupled the size of its physical therapy to accommodate the needs of its residents, 98 percent of whom are wheelchair-dependent. The recently completed expansion includes the acquisition of wheelchair-accessible weight-lifting equipment and whirlpool baths. The weight-lifting equipment allows for the exercise of most major muscle groups and comes with several unique features, including weight lifting "cuffs" for residents lacking the fine motor skills to grasp a pulley handle.

Another form of exercise that's less strenuous but still highly beneficial is getting immobile residents on their feet for limited periods of time. This can improve digestion and blood circulation, strengthen bones, and boost morale--but it can't be done without mechanical help. A stationary standing aid, which operates by a hydraulic system, pulls the resident up from his or her wheelchair into a standing position using a secured harness. The standing aid then supports the resident securely until therapy is completed.

* Giving caregivers a break. Transferring non-ambulatory residents from bed to toilet or bath can be taxing for caregivers--and traumatic for residents. To alleviate some of the hardship, Beechwood has invested in several devices. For example, its whirlpool bath comes complete with an adjustable lift system to facilitate the transferring of immobilized residents from their rooms to the tub. With the lift system there are no more multiple transfers. The wheeled lift is designed to fit over residents' beds. Residents are rolled onto the lift and transported to the bath. Once there, the lift descends into the tub and the height is adjusted for ease of reach. When a bath is over, the caregiver simply raises the resident, towel-dry him, and takes him back to his room.

* Treating heart attacks. A new form of defibrillator can examine a patient's electrocardiograph and prompt medical personnel on how to proceed. It will administer an electric shock only if the patient is actually in cardiac arrest. ACTS recently placed this lifesaver in every community, as well as its corporate and regional offices. "We had an incident in one of our communities where a resident was undergoing cardiac arrest," says Patti Thebus, director of medical services. "The resident was able to notify the resident community nurse, who successfully administered the defibrillator, restoring the resident's heartbeat until medical personnel could arrive and take the resident to the hospital."

* Reducing paperwork. The Visiting Nurse Service of New York, a not-for-profit home care company developed computerized pen tablets for all of its 1,500 nurses. "We've been developing this system since the early nineties," says Rick Stazesky, director of information systems. "Our goal has been to put full computing capacity into the hands of our field staff professionals."

Not long ago, VNSNY nurses were doing everything manually, from filling out care plans to noting routine care documentation. Now the nurses are virtually paper-free.

The pen tablet, which is slightly smaller than a laptop and weighs about three pounds, is operated by touching a keypad template at the bottom of a computer screen with a pulse-emitting, battery-operated pen. At the end of the day, the user simply hooks the pen tablet to a phone jack and, within seconds, it is transmitting the collected data to the central office.

With this time-saving device, VNSNY's nurses can make changes to patients' care plans (signing them electronically), send and receive e-mail to and from doctors and colleagues, and document communications concerning their patients' care. The pen tablets are even outfitted with a medication database that warns of possible side effects and contraindications.

Aegis, an assisted living chain based in Redmond, Washington, has as many as fifteen computer alcoves in the hallways of some of its facilities for quick and easy access by caregivers. The idea, says President and CEO Dwayne Clark, is to maximize the amount of time its staff has for residents. Aegis has also developed census software that allows caregivers to input extensive biographical information about residents, such as their favorite blanket, dessert, or when they like to snack. Aegis has even developed a software program called "Small Indulgences" that prompts staff to suggest that a resident might take in a spa, a massage, or aromatherapy.

* Tracking therapy minutes, A wireless therapy-tracking device allows therapists to post therapy time directly to a centralized database, enhancing accuracy and promoting efficiency of service. Unlike complicated hand-held devices, the therapy-tracking device uses cellular telephones with digital screens or alphanumeric pagers, depending on your needs.

Before therapy begins, the therapist simply pulls up the patient's name and selects "yes" to start treatment. In real time, the device automatically subtracts therapy minutes from the patient's RUG category. When the session is completed, the therapist selects the "end session" button. The device can also be programmed using CPT codes for Part B patients, allowing subtraction of therapy time in dollar figures.

* Encouraging drug compliance. New drug compliance aids help remind residents who administer their own medications when it's time to do so. Aids range from basic timer devices to sophisticated remote-alert and message-paging systems. For example, a small remote alarm device, which can be worn like a key chain or necklace, is programmed to sound an alarm when it is time to take medications. The device beeps until deactivated.

A new hand-held pulmonary drug management system combines a drug delivery device with computerized assessment capabilities to ensure that respiratory care patients receive optimum benefits from their respiratory drug treatment. The system monitors patient-use technique, medication compliance, and lung functionality. Data is downloaded to a computer to provide clinicians with the information they need to pinpoint problem areas and make sure patients are self-administering properly.

* Keeping tabs on residents. At Southern Assisted-Living, a Chapel Hill, North Carolina-based assisted living chain, residents wear computerized emergency call devices around their necks. The pendants can also be attached to a belt or purse or placed at the resident's bedside. Meanwhile, wall-mounted transmitters are located in residents' bathrooms and in all common areas. A push of a button signals a central computer, which activates staff pagers. The call system can also track types of calls and staff response times, notes Rich Williams, operations manager.

As part of its Alzheimer's program, Gadsden Health Care Center Inc., a 168-bed skilled nursing facility in Gadsden, Alabama, puts a small transmitter, which looks like a piece of jewelry, on a bracelet worn on the resident's ankle. When the resident nears an exit door, the door automatically locks, sounds an alarm, and notifies the nurses' console, identifying the resident and the exit location. The transmitter operates by radio frequency and uses a battery pack as a backup in case of power failure. Like any piece of technology, says Cleo Phillips, Gadsden's office manager, you have to work around its quirks--thick stockings over the device inhibits its effectiveness and it sometimes malfunctions during electrical storms--but all in all, she likes it. "It puts us a little more at ease," she says.

A clever motion monitoring device is an ultra-thin, virtually undetectable pad that warns nurses when a resident is attempting to get out of his or her chair or bed. When pressure is no longer being applied to the pad, the control unit activates call signal at the nursing station or sounds an in-room alarm.

Another recent innovation combines fall-prevention monitoring with incontinence monitoring. The linkage makes sense: Many incontinent residents attempt to get out of bed or up from their chair because of wetness and irritation to the skin. This two-in-one system gives caregivers a more effective way to prevent falls and alleviate skin irritation and ulcers.