Making the most wander control technology.

Manor HealthCare is showing how management can put it to best use

Recent advances in wander control technology are making the systems and devices more user friendly for nursing home staff and residents alike. Resident monitoring systems that now have a battery life of anywhere from one to four years are less labor-intensive with respect to maintenance. The ability to do spot checks on system operations has also been facilitated. Rather than relying on system activation to determine whether a system is operating, handheld devices can now be placed against the resident's transmitter to check its operational status.

Other advances are helping to better customize monitoring capabilities. For example, a Florida vendor is now marketing a product that is similar to a resident monitoring system, but rather than being limited to a specific doorway, the system's signal band can be adjusted to monitor an entire hallway or floor. The only drawback to this system is that the transmitters are relatively bulky.

The size and configuration of transmitters in general, though, are beginning to change in response to the need for greater attention to residents' dignity. We're now starting to see some smaller, more discrete transmitters - even some that are made to look like jewelry.

Despite these significant advances, it's important to avoid the trap of over-reliance on transmitters placed on nursing home residents. Even the more sophisticated wander control systems cannot - and should not - be expected to take the place of sound management policies and procedures. Effective wandering and elopement control depends upon proactive administrative controls that are enhanced by, not replaced with, hardware and technology. It is this administrative control that should be viewed as administration's first line of defense against wandering and elopement, and it should be in place well in advance of any decision to select hardware.

Table 1 lists some of the general considerations that should be addressed when developing a resident security/missing resident program. In developing such a program, it is wise to ask yourself some basic but critical questions before making the decision to "go high-tech":

- Do you have a set of policies and procedures ensuring resident accountability on a regular basis?

- Do those policies and procedures include protocols to be followed when a resident is reported missing? (Resident elopement can occur despite the best management and most highly sophisticated technology.)

- If you intend to purchase a system for a single unit within a larger facility, are your rotating staff trained to use the system?

- Have you looked at all possible ways of making your facility more secure, ie, conducting a risk assessment of your building before jumping into the acquisition process? That assessment should include a walking tour of the facility to determine the areas in which residents are most likely to attempt to exit and any secondary or indirect areas that may pose greater-than-average monitoring challenges.

Once the assessment is complete, you can begin to build a profile of exactly what it is that you want an anti-wandering system to do for your facility before sitting down and talking to your vendor.

Selecting a System

Table 2 lists several considerations involved in selecting a wander control system that will meet your facility's unique and specific needs. While most vendors we've dealt with are very good at finding and tailoring a system to meet specific needs, there are some who may try to sell you some high-tech "bells and whistles" that you may not want or need. Doing your homework beforehand is the best way to ensure that your needs will be met in the most cost-effective manner.

The technology you select may be the "latest and greatest," but if it doesn't work for your facility, it is of little value. For example, the "user-friendliness" of a system goes a long way toward ensuring that the system will actually be used. False alarms or key pads that don't work or wear out quickly may prompt staff to disable the system ("accidentally on purpose") just to avoid these inconveniences.

It is a good idea to walk the facility and check for any blind areas in which alarms can't be heard with a normal system; a second alarm system or an annunciator panel may be needed. "High-risk" exterior perimeter doors may also need to be alarmed in addition to the interior exits covered by resident monitoring systems. In addition, battery or emergency generator backup can avert disaster in the event of a power outage.

Technology Survey

Manor HealthCare is dedicated to providing the least restrictive atmosphere possible for our residents, while still ensuring resident safety and security through appropriate administrative and technical tools for effective resident monitoring. In keeping with that goal, we've just completed a survey of our 90 Arcadia units (secure special care Alzheimer's/dementia units within our skilled nursing facilities) to evaluate the security systems in place. Buildings with Arcadia units were selected for the survey due to the higher risk of elopement by residents with cognitive impairments. According to Carol Simpson, Manor HealthCare's Public Information Manager for Alzheimer's Services, "The neurological changes that occur in people with Alzheimer's disease cause confusion, disorientation and, often, 'wandering' - feeling they need to go somewhere. Although this phenomenon can be short-lived, it puts residents at greater risk of elopement. Everything in Arcadia has been developed to promote resident safety, independence and dignity - initial unit design; availability of stimulating and success-oriented activities day and evening; well-trained staff; comfortable familiarity of a homelike environment; secured outdoor space to walk; and, last but not least, adequate safety policies and technology."

Arcadia units employ the following types of technology: electromagnetic locks, stairwell alarms, resident monitoring systems (receiver and transmitter) and various combinations of exterior door alarms, such as delayed egress systems with coded key pads, etc. Staff members were asked to rate these systems with respect to effectiveness, any problems they've encountered, and any logistical considerations, such as areas of the facility in which it is difficult to respond to an alarm.

Operating issues reported by staff have ranged from key pads that wear out quickly, necessitating two or three attempts to punch the code in before the system will operate, to false alarms or alarms that are not sufficiently responsive. Other concerns center around the need for system upgrades. The technology changes so rapidly that facilities that have invested time and money in a system four or five years ago may now find that the system is inadequate.

Survey information collected supports the use of resident monitoring systems to supplement existing hardware in some facilities. We hope to determine the optimal anti-wandering configurations as based on a typical facility and, from there, to make improvements as deemed necessary in Manor HealthCare's 170 skilled nursing facilities.

The Future

Residents' right to dignity should be a primary concern when designing wander control devices, and personal transmitters will become smaller and less obtrusive. Some of today's pricier systems will become more affordable. Monitoring sophistication will be greatly enhanced over the next three or four years, with the capability to plug personal profiles into transmitters and alert staff instantaneously to the identity of the resident attempting to exit and his or her precise location.

As new technologies are being developed, refinements in today's systems will help to make them more effective and user-friendly. Already, vendors are informing us that door systems are becoming more sensitive, while false alarms and delayed activations are being virtually eliminated.

These technological advances, when used to enhance the actions of staff trained in resident wandering policies and procedures, will provide the skilled nursing facility with its best defense in deterring resident elopement.

RELATED ARTICLE: Table 1. Resident Monitoring/Missing Resident Program

Develop an assessment protocol to identify residents who are prone to wandering and/or elopement.

Perform a facility-specific risk assessment to identify means by which disoriented residents may gain access to hazardous areas (e.g. boiler room) or unobserved egress to facility exterior.

Based on the risk assessment, install resident monitoring/security devices as needed and appropriate. When in doubt, consult with local fire service/code enforcement personnel concerning the installation and use of monitoring/security devices.

Develop concise, easy-to-follow procedures for staff response to monitoring/security system activation.

Train staff members in the use of facility resident monitoring/security devices and missing resident response procedures.

Periodically test the staff response by performing monitoring system activation and missing resident drills. Use post-drill critique information to evaluate whether revisions are needed to the facility's policies/procedures and/or training programs.

Ensure that resident monitoring/security considerations are accounted for during the planning and design phases of facility expansion and remodeling projects.

RELATED ARTICLE: Table 2. Resident Monitoring/Security System Considerations

Does the system:

provide continuous activation until a formal system reset procedure is performed?

incorporate a reset procedure that requires reset at the point of activation?

provide a readily detectable audible and/or visual indication when the system has been activated? Can system activation indicators be seen and/or heard during peak periods of facility activity?

possess a standardized operation method (e.g. a four-digit code) that allows easy staff access but deters unauthorized or random system release/override?

incorporate a battery backup or emergency generator connection to ensure system operability during electrical power outages?

possess a test/calibration function in order to periodically test/verify system operability?

comply with all applicable fire safety regulations (e.g. NFPA Life Safety Code)?

Chris Davis is Safety and Loss Control Manager for Manor HealthCare Corporation.