Wanderer departure systems: high-tech, low-worry.

It's every nursing home administrator's worst nightmare: a confused resident whose whereabouts are unknown after wandering off the unit or - even worse - the nursing home grounds. But the mandate from OBRA is clear: restraints, both physical and chemical, are not to be used routinely as long-term solutions to any problem. This leaves the nursing home staff with the challenge of ensuring the safety of their confused, ambulatory residents while maintaining their personal freedom. Achieving that delicate, and often precarious, balance is especially crucial in light of the growing number of nursing homes with special care units for Alzheimer's patients - those residents who are among the most likely to wander.

The manufacturers of electronic wanderer departure systems continue to respond to this dilemma with increasingly sophisticated technology designed to address the freedom vs. safety dilemma. The systems vary considerably with respect to technical features, capabilities and available options. They range from simple door alarms to all-purpose computer identification systems which identify the wanderer by name, date, time and location while triggering the alarm and locking the door in the protected area.

In general, however, the wanderer departure systems fall into three general categories:

Passive tags. A concept borrowed from the retail market, these disturb electrical or magnetic fields produced at the door being secured, rather than emiting signals of their own. Passive tags have the advantage of being relatively inexpensive and requiting no batteries, but have a limited range of operation. Some experts cite false alarms or non-detection as possible disadvantages of passive tag systems.

Active tags. These emit a continuous signal, thus giving them a much larger working range and the ability to be detected anywhere, including outside the facility. Some active tags are "non-intelligent," meaning they cannot identify the wanderer, while some are designed to identify specific residents or more than one person going through an exit. The tag life of such systems varies and facilities will need to replace the sensors periodically.

Transponder tags. Essentially active sensors in a "sleep mode," they are activated when they enter the electrical field of a protected area. Their effective working range is sometimes limited. "Smart tags" are transponder sensors which usually provide the user with the option of wanderer identification with an array of alarm tones, and have a relatively long operating life of seven years or more.

Other systems, such as bed and chair sensors, are designed to prevent falls by alerting staff when residents attempt to leave the bed or chair unassisted.

In an attempt to sort out the array of products available, five manufacturers of wanderer departure systems responded to questions posed by NURSING HOMES Managing Editor Laura Bruck. While their systems provide a monetary benefit by reducing the need for additional staff to monitor residents' every move, the manufacturers stress that the technology is intended to enhance, rather than replace, staff attentiveness and dilligence.

Contributors:

Ted L. Algaier, President & CEO, Accutech/Innovative Control Systems, Inc.

Harold Baldwin, President, Secure Care Products

John Brasch, President, Senior Technologies

Glenn Jonas, President, RF Technologies, Inc.

Steven Mildenberger, Business Manager, Tracking Devices, Instantel Inc.

With such an array of systems on the market today, how should nursing homes go about deciding which system is best for their facility - and how does your company's system fit in?

Algaier: Health care facilities should first do their homework on the manufacturers of wanderer departure systems. Several issues need to be addressed by asking the manufacturer questions, such as the following:

"How long have you been in business?"

"Has your system ever been replaced by another manufacturer's system? If so, why?"

"How many customers do you have?"

"Can you provide at least ten references?"

"How is the product installed and serviced?"

"Does the system false alarm; what is that percentage?"

"What is the percentage of tag failure?"

"Will you do a site survey and demonstration at our facility?"

"Is there a facility we can visit to see the product in use?"

Asking for references and requesting the chance to see the system in use at another facility is especially useful since it is the user, rather than the manufacturer, who is the best judge of the system.

Flexibility is one of the most important considerations in selecting a system. Our three monitoring systems range from low-end simple alarms to high-end computer identification. All three integrated systems - Single Zone, Multizone and our newest system, the Accutech VP (Value Package) - use a transmit-and-receive aerial at the monitored door or zone. This can be located on each side of the door, a loop surrounding the door, or a mat secured to the flooring. The systems are activated by a transponder-style sensor, all of which have a seven-year limited warranty.

Baldwin: Any facility considering the purchase of a system should look for several key elements in the products, as well as in the companies providing those products. For example, how reliable is the product, and are trained local service personnel available? After all, resident safety and facility liability are the primary reasons for installing a system.

lt's also important to find out which companies are willing to provide on-site facility audits to assist with system design based on facility need and layout. Facilities should also inquire about which companies will provide certificates of product liability insurance, etc.

We've seen many improvements in the equipment used to monitor wandering residents over the past six years. Secure Care Systems meets all the needs outlined above and was the first to develop these products, starting with alarms that sound when a wanderer tries to exit a facility. We then developed Smartloc, which quietly locks a door only when it is approached by a wanderer. We've interfaced our system with a variety of devices such as CCTV cameras, pagers, voice modules, elevator lockouts and long-range security cameras.

Brasch: Facilities want to protect their residents at-risk in a complex environment. They do this with good staff supported by valuable protocols. That must come first. Boundary alarms such as the WanderGuard departure alert system are a back-up support for well-implemented procedures and programming.

WanderGuard systems are designed, first of all, to support and "piggyback," if you will, management systems already in place, e.g., the MDS. Since the emphasis is on resident-centered care, assessment of the resident to determine which of two signalling devices is most appropriate is as key to WanderGuard's program as the equipment itself. Therefore, potential purchasers of this type of equipment should ask: Does the manufacturer just offer equipment that will come in a box, or does it provide a program that includes assessment and protocol guides, ongoing communication via phone and periodic newsletters, videos to orient staff and families, and a range of product options? Will the manufacturer be in business over the long haul? Can the manufacturer provide satisfied user references in all 50 states and Canada? Is the system simple enough for the user to install, but in the event of problems, can the facility speak directly with the manufacturer's technical representatives for assistance? What about warranty repairs, exchange programs, etc. - who pays for what?

Generally speaking, the prudent business decision rests on much more than the upfront cost comparison.

Jonas: There are a number of decisions involved in selecting a system, and no single factor, such as facility size or layout, will determine which system will best meet your needs. Instead, a range of factors, such as the following, should be considered:

* The traffic pattern of the area to be monitored.

* The types of emergency alarm systems in the facility.

* The location of nurse's station relative to the door/area being monitored.

* The location of the facility: hazards or unsafe areas in its proximity.

* The number of floors.

* The number of wanderers.

* The behavior patterns of the resident population.

* The layout of the facility.

* Budget

* Elevators to be monitored.

All of these factors are taken into consideration when we work with facilities to tailor a system to their particular needs. Code Alert offers a variety of restraint-free systems and enhancements designed to meet a range of needs at differing budgets. Accessories include Voice Alarm, staff alert products, National Fire Protection Association 101 electromagnetic CodeLocks, elevator deactivation devices, the VisiNet identification system and pager alarms.

We also have a new line of bed and chair alarms that operate with advanced microprocessor-based technology. These alarms provide staff with advance warning when a resident attempts to leave a bed or chair without assistance.

Mildenberger: Wander systems vary significantly with respect to available features, and facilities should shop for the features and additional hardware they require. Resident population is an important consideration. A facility with only a few wanderers may not need the identification of each reported, since their habits are known to the staff. But as the number of wanderers increases, staff response depends upon knowing who triggers an alarm.

The facility should consider the cost of each installed door or other protected area, the cost of installation, which varies a great deal, and the short-term and lifetime cost of the tags. The dollars you save on a system may be spent many times over on tags during its operating life. Most (but not all) basic systems can control magnetic locks. Many suppliers will try to sell you magnetic locks, video systems and other devices, most of which (even the same brand names) can be obtained by your installer much more economically from a local security distributor.

Facility size is generally not an issue since most systems are not limited in the number of doors that can be protected. With larger systems, you may want alpha paging capability and wanderer identification. A portable locator is very useful for finding tags which may have been cut off and hidden by a wanderer.

Facility layout is a consideration but usually does not preclude the use of any particular system. For the protection of double doors or wide corridors, some systems need extra equipment, which adds to cost. WatchMate does not. If it is necessary to protect an outdoor area such as a patio, particularly in 30-degree weather, WatchMate may be the only system that can do the job.

The most critical technical consideration is the system's ability to detect real wanderers without false alarms from electrical interference (video monitors, vacuum cleaners,

clothes dryers, etc.) Instantel's WatchMate systems use crystal-controlled electronics, microprocessors in every tag and a special FM-encoded signal to prevent interference. (Listening to the difference between FM and AM radio reception during an electrical storm will illustrate the importance of the FM-encoded signal).

The nursing home should also check the supplier's references and make certain they have a local authorized representative to train staff, provide technical support and work with the facility on upgrades; some manufacturers ask you to ship equipment back to the factory if you have problems.

Finally, your system should be able to grow and change with your needs. WatchMate allows new software features and enhancements to be added by your installer without removing the equipment from your facility. In addition to the standard functions, WatchMate offers a number of other features including a portable locator, alpha paging and color graphic alarm display.

What types of new developments or refinements can we expect to see in this technology over the next few years?

Algaier: Further Accutech developments may include the following:

* smaller tag size

* ten-year tag

* enhanced software

* multi-task software

* wireless installation

* wireless nurse locator systems

Baldwin: Future developments should include computer-based systems which can be programmed to provide a variety of services at any given door or location, depending on facility needs. As these designs are developed, I believe there will be a greater focus on facility security to ensure the safety of residents and employees, and to reduce facility liability.

Brasch: While the hardware will continue to improve as new technologies become practical, the most essential improvements for resident safety will come from good protocols, good management consistent with the MDS and caring, informed staffers. Without getting into proprietary information, we have some very nice technical surprises that we're working on.

Jonas: Those suppliers with in-house staff engineers operating in a variety of synergistic fields, such as RF Technologies possesses, will continue to offer new developments on an ever-accelerating basis. Such refinements, to name a few, may include supervised systems, wireless installation design approaches, and RS485 or neuron-chip communication protocols.

Miidenberger: The next few years should bring additional features at the same, or lower, cost. We may see more general availability of features now offered only in WatchMate. Also look for the integration of wander systems with nurse call and access control in larger facilities.

The many new features and capabilities available in future products will challenge the nursing home staff to become aware of the products available and to know exactly what their requirements are before selecting a wander system.