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Assistive technology in the ALF: monitoring technology can lead to better senior living.

No longer evoking fears of "Big Brother," personalized monitoring technology has gained popularity over the past several years. Consumers, including long-term care residents, have started to understand and welcome the advantages this technology offers.

Many individuals who historically would have been dependent on institutional supports can now use noninvasive assistive technology to live in homelike settings, such as assisted living communities (ALF).

Long-term care providers, including ALFs, spend much of their time juggling regulations and increasing resistance by consumers to the institutional model of care. Historically, residents' families and friends have worried about the care their elders receive in the ALF setting and have clamored for assistive devices such as personalized monitoring to help them balance parenting for their own children and provide appropriate care--often long distance--for their elderly loved ones.

There are also case managers who assist ALF residents in getting the care they need. These individuals have long been the backbone of identifying proper supports for residents, but a combination of decreased funding and increased caseloads has limited their options to crisis management. Think about how they might benefit from being able to monitor ALF residents from afar.

And finally, community agencies and providers have long emphasized supports to keep residents as independent as possible, but they struggle to attract and retain qualified caregivers to aid residents, even as the number of support requests grows.

Tech-savvy solution

Fortunately, monitoring technology can be used in the ALF setting to solve several issues. Here are a few samples of how monitoring technology increases opportunities for resident independence in the ALF:

1. Family and friends can access the Internet at any time and from anywhere to trend activities such as sleep patterns, meal preparation, or the timeliness of medication dispensing. Caregivers can design customized parameters to be notified of exceptions to normal everyday patterns, such as prolonged inactivity, a door or window being opened at unexpected hours, or an electric stove being on for longer than normal. Automated phone, text message, and e-mail alerts can let families and friends know immediately if there's a potential problem.

2. Case managers can access individualized reports containing valuable information about an ALF resident's daily activities. Using this information, they can create a more accurate and useful individualized support plan. Additionally, they can verify visits by professionals (e.g., nurses, physical therapists, occupational therapists, etc.) through the use of an entry and exit access code.

3. Community and home health agencies can use medical and disease management devices to analyze data trends as well as receive notifications for specified data anomalies. Data are stored at a password-protected Web site. There is also a benefit in tracking employees through access codes to ensure accurate billing.

4. ALF providers can be part of the paradigm of community services by becoming part of the response team of caregivers. ALF employees can receive alerts and notifications for certain types of nonalarm events for which central station response might not be appropriate or effective.

This direct monitoring connection between the consumer and the assisted living center allows for a more tailored response in the event of a potential issue at the residence. It also lets care providers establish an early link with potential ALF residents who currently live independently but may need long-term care support in the future. By using electronic monitoring, ALF providers can offer their potential consumers supports to age in place.

With all of these advantages, what is preventing technology from being embraced as a form of service and support by ALF residents? Following are some of the hurdles standing in the way of monitoring devices:

* Funding obstacles: Much of today's long-term care funding comes from Medicaid and Medicare systems designed in the 1960s, when little affordable technology was available. New support systems make better use of limited resources. Most states already have, or are in the process of implementing, proper funding mechanisms to cover electronic supports, thereby stretching the available dollars while increasing residents' options.

* Fear of what we don't know: By embracing the concept of electronic monitoring, many seniors, caregivers, and service providers will be exposed to new equipment and to a new service delivery system. ALF residents may fear that they are being spied upon or are losing opportunities to touch base with their family members or caregivers. ALF caregivers may believe they are being replaced or forced to become computer geeks, induced to give up traditional hands-on caregiving to sit behind a screen all day. Using technology for monitoring support and data collection will require ALF providers to learn and use a new skill set. It is human nature to avoid something we perceive as challenging or difficult.

* Fear of losing control over what we know: Healthcare providers have always had to rely on what people tell them. Not all consumers recognize trends in their own behavior or are aware, forthcoming, or totally truthful about their problems. Just what will a sensor sense? Residents may have concerns about this that you will have to help them overcome.

* Fear that technology will replace the care component: Contact with family, friends, and the community are vital components of a resident's everyday life. Will being able to log in or receive a text message replace direct interactions? This is another area in which you may need to ensure your residents that monitoring technology won't replace the assistance they already receive from your staff.

To implement technology as a valid platform of service provision, ALF providers, caregivers, and family members must integrate these tools into the continuum of care. Caring for people requires being with them. Technology should enable and inform caregivers--not replace them.

A field guide to monitoring devices

Some of the monitoring technology currently available for the senior housing and care markets includes the following:

* Personal emergency response systems

These devices are standalone systems of limited scope that may require a long-term contract. The responders are usually police, fire departments, or emergency medical services (EMS) personnel. The facility will incur charges for fire department and EMS responses as well as for false alarms.

* Central station monitoring

Monitoring in this scenario is provided by a licensed security company. Central station monitoring limits the types of events monitored and the reports and data available to residents or care providers. The role of the central station should be to supplement--not replace--local care providers, such as assisted living facilities (ALF). That's because ALFs have the advantage of relationships with residents and knowledge about their particular situation and history.

Residents and care teams should know exactly what to expect from a central station system. Questions to ask the security company include, "How does the central station system ensure that it has current data on which to base a response?" and, "Will this system provide notifications to the caregiver support team?"

* Prepackaged systems

These systems are available through retail outlets and infomercials. They usually have limited reporting features and expandability.

* Personalized activity monitoring systems

Some of these systems are expandable and allow creation of an individualized plan of support with flexible notification options, but without requiring a long-term contract. Look for systems that can accommodate unique devices, such as stove and pressure sensors and medical monitors.

What are the costs?

Hardware costs typically range from $200 for a personal emergency response system to $500-$950 for a basic, but individualized, monitoring system. Specialized systems cost more.

Monthly costs generally begin at $40 but can go much higher depending on the level of oversight offered and whether the service plan includes central monitoring. Central station monitoring services may require an extended contract of one to three years.--Allen Ray

Allen Ray is president and CEO of Community Management Initiative (CMI), Inc., a company that delivers programs, supports, tools, and services designed for caregivers of the elderly and disabled. Through affiliations with CMI and other companies, Ray has been involved in providing services to seniors and developmentally disabled adults since 1989. If you have questions or would like more information, please contact him at or call 888/684-3581.
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Article Details
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Author:Ray, Allen
Publication:Contemporary Long Term Care
Date:Apr 1, 2007
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