A

ccess is a growing concern of every nursing home, whether it is a facility dedicated to continuing care, extended care, or, increasingly, both. Access is a big part of making residents feeling comfortable, as though they are in control and treated individually. Whether it is access to another part of the building, the gardens, the outdoors, or to common areas, the bottom line is that if residents are capable and allowed to move about, it is better for everyone. That includes the residents themselves, family members, and facility staff who provide care to residents and want to see them happy.
       Increased access improves the care of those residents suffering from some type of dementia, which, according to The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is about 68%. The more they interact with others and get physical exercise, the better. Plus, increased access imparts to residents a sense of home; in their traditional houses, apartments, or wherever they formerly lived, they were free to move about at will. Why not in the new home, too? Access empowers, does wonders for their independence, and imparts a feeling of stability.
       Potential residents and their families are viewing nursing homes with a new sense of permanency. They are less willing to see a facility as transitional. When they retire, they want familiarity; about 76% of persons 60 years of age and above stay put after retiring.¹ When the time comes to move into a facility, residents want to stay there, even as their care needs grow. To them, a nursing home is not a place to pass through for a few months or years. They want the facility they initially entered to be home for the rest of their days. No one wants to move a secure-feeling loved one from a facility he or she has come to know as home to a new place where the person has to start all over again. That is jarring for everyone. Facilities would rather work toward providing appropriate levels of professional care; from a staffing and business perspective, long-term relationships are much better for them.
       But how does a facility balance access and safety in a resident-centered environment? That is difficult enough to answer when care levels are basically the same across the board. It gets much more complicated when residents are affected with dementia and/or prone to elopement or violence. Traditionally, it has meant exit doors had to be locked, in which case staff had to continuously escort able-bodied and able-minded residents to destinations they were perfectly capable of reaching themselves. Besides being demeaning for residents who were already feeling down about their loss of independence, escort duties tie up staff members who could otherwise be tending to important matters.

Balancing Access and Safety

       Facilities are increasingly being challenged to provide access-control and wander-prevention systems that can accommodate the changing security and safety needs of their residents. By monitoring residents prone to elopement (via electronic technology contained in innocuous wrist bracelets or pendants), they permit personalization and categorization, better access for residents, improved conditions for staff, and advances in accountability. This approach promotes a much higher degree of freedom for residents, while serving as a passive yet highly effective restraint.
       Here is how it works. The electronic bracelet or pendant emits a continuous radio frequency signal to a reader at a door, which is programmed to lock when the resident approaches, sound a silent alarm, and summon staff via pagers. The system sends staff precise information about who has triggered the alarm and his or her whereabouts (known to the system by a series of location beacons strategically affixed throughout the building) so staff members can respond efficiently. There is no need to go back to the main desk to verify information, which makes staff more mobile and responsive—and timely, when minutes count.
       Indeed, finding and identifying residents with precision is key. It means having the ability to locate residents in hallways, bathrooms, suites, and common areas, which these technologically driven radio frequency systems allow.
       Residents who are not prone to elopement have a new level of freedom. They can pass at will. Doors that were once locked to these residents can now be opened; there is no need to deny them access to where they want to go. For example, facilities like Silver Creek Leisure Living (Bull Head, Ariz) offer extensive outdoor recreation opportunities to ensure a higher level of watchfulness without additionally restricting all residents. Silver Creek chose an automated system to monitor the driveway and another key exit where residents might wander.
       It is not just the healthfully minded individuals who benefit—the integrated technology systems enable all residents to wander freely in secure areas, such as common areas and gardens. At the same time, the system acts as a gatekeeper to safeguard wandering residents from the risk of elopement. For example, at California’s Folsom Convalescent Hospital, a skilled, privately owned nursing facility, administrators wanted their 9 residents suffering from dementia to have the same kind of freedom as the facility’s other 90 residents. They installed a multi-identification system that allows them to keep an eye on residents near exits.
       “Prevention is a staff-driven activity,” says Diane Hosson, who is responsible for marketing at VeriChip Corporation, which manufacturers and installs anti-elopement technology like RoamAlert. “The more intelligent and versatile the system, the less staff intervention is required.”

The Effect on Record Keeping

       One of the biggest challenges many facilities face is detailed record keeping, a universally held problem as regulators intensify nursing home accountability. With automated systems like RoamAlert, computers log all events centrally. The results can then be used as an assessment tool to monitor patients’ behavioral patterns. For example, it is well known that dementia sufferers are given to habit. So, if a resident with dementia is logged going to a door at a specific time every afternoon and gets agitated when it is locked, the facility can try to provide an alternative activity at that time to otherwise occupy the resident. That shows inspectors that the facility was aware of a situation and took action. The complete record of events is crucial and allows facilities a new level of post-event analysis, with which they can show trends and key on certain areas to improve internal training.
       Many facilities appreciate that an automated system can be used to document behavior patterns for family members, which lends credibility and clarity to care decisions. When family members visit, they see the system in action and no longer have to learn and remember a keypad code. The system is mostly invisible or, at the very least, unobtrusive and aesthetically blended into the rest of the facility’s décor, eliminating the perception that an electronic eye is always on guard.
       Taking a proactive approach to wander prevention is important. “We do an assessment for elopement risk on every incoming resident and have them wear a [RoamAlert] bracelet for three months,” says Sandra Griffin-Bukowski, Vice-President of Health and Wellness and Nursing Home Administrator for Brethen Village (Lancaster, Pa). Anxiety and confusion are common responses to a change in environment, she says, and the 3-month trial period gives staff time to evaluate each resident fully.
       At the end of this period, the staff of Brethen Village reviews information from the RoamAlert system and the resident’s medical chart to determine whether he or she should continue to be monitored. Even after the evaluation period, almost 90% of residents in the healthcare center remain monitored by the system. It is an effective way to ensure that residents are safe, with a minimum of intrusion on personal freedom. Because when it comes to choice, automated security systems that can meet the ever-growing demands of their residents could be the difference between whether residents or loved ones choose one facility over another.