Wander management systems

Resident wandering/elopement has been a serious issue in long-term care for decades, both in terms of patient safety and liability concerns. The National Institute for Elopement Prevention and Resolution notes that 10 percent of all litigation against long-term care facilities involves an elopement, citing data that shows the average out-of-court settlement in 2009 was close to $400,000.

Technology solutions have helped, especially the use of active RFID tags worn on wrist or ankle bracelets and linked to signal detection devices that can trigger an alarm when a patient wanders too far from their room. Although many vendor offerings use the same basic technology, long-term care executives need to consider many factors when weighing the technology options and issues of cost, scalability and integration.

Long-Term Living asked several vendors in the wander management space to describe how their solutions have evolved and what features and trends are becoming more important to customers.

Paul Constant, director of sales and marketing at Secure Care Products LLC, noted that his company has been in business for 35 years and was the first to manufacture a wandering-resident solution. “Our Door Guardian solution has significantly evolved over time, although it still uses radio frequency technology,” he said. “A resident wears a transmitter like a watch or bracelet on wrist or ankle and we create a detection zone at the door with an exit panel. Many years ago the antenna was in a floor mat. The resident would stand on the mat and it would send a notification that a resident was about to go out a door they were not supposed to.”

Over time the transmitters have gotten smaller and the technology has improved, so Secure Care has been able to do a lot more with the information when a resident gets to the door, he added. “We may lock that door. If it is open, we will send off an alarm,” Constant said. “We have electro-magnetic locks we integrate with to lock the door, so the resident can’t get out. But if someone is holding the door open, we are going to let you know that Mr. Jones may have gone out that door.”

The system used to send that information back to a nurse station in the form of an alarm. The technology has improved over time, so now the software is able to understand that when an alarm goes off at a door, it is Mr. Jones, wearing Transmitter No. 1234. “We can have a photo of Mr. Jones come up on the software, and we can also let you know if it is a door alarm or a door alert,” Constant said. “We give you high-level information right at the computer.”

Integration with nurse-call systems

Integrating wander management solutions with other systems such as nurse call is becoming more important, said Chris Konicek, sales and marketing director for Accutech.

“People want as few systems to manage as possible. They want a completely turnkey approach. Everybody wants one throat to choke,” Konicek said. “That requires tying as much hardware as possible to a single user interface, and that is what we are doing with our systems.”

For instance, Accutech’s 2-year-old LS 2400 system has custom integrations with most major players in the nurse call space. “We take our information and put it in a format that can be sent over a network protocol and the nurse call system picks it up and brings it into their software,” Konicek said. “You don’t need our software to see our alerts. You can use the nurse call system software to run reports on the wander management system. You can use the nurse call software to show a picture of the resident who has wandered away or is creating the alarm.”

Reducing stigma

Jared Pitney, vice president of sales, senior living, for RF Technologies, said that with its Code Watch product the company is trying to get away from an institutional feel and move more toward a home-like environment. “We are trying to get away from the stigma that the patient is a problem or there is something different about them. We are getting to a customization, where they can take a picture or something from their memory box and put that on the Code Watch. The feedback we get is that that is going to lower the stigma that the person feels. Now they are not looking at it as a transmitter, but more of an accessory piece.”

Along these same lines, all the vendors we contacted mentioned that their systems have the capability to track residents in secure courtyards. These are increasingly popular features, because it gives residents the freedom of movement without sacrificing safety.

Mobile apps

Increasingly, long-term care facilities are asking for notifications to be sent to employee smartphones. SecureCare has an mVision mobile application that allows users to receive and acknowledge notifications on mobile devices about their Door Guardian wander prevention system. When events happen, the facility can set up which users they want to receive notifications. In a bring-your-own-device environment, the users can download the app on an iOS or Android device. Then, in real time, nurses get the same notifications they would get through the computer solution: the patient’s name, the location, what type of event is happening. They don’t need to be near a door panel or the software to understand what is happening.

Cut-band alerts

Many systems can be enhanced with cut-band technology. “If a resident were able to get ahold of something to cut the strap off, it signals a cut-band alarm and lets you know he has removed the transmitter from his wrist or ankle,” Secure Care’s Constant said. “We lock down all the doors in a secure area.”

Konicek said Accutech also offers a cut-band option, but he said it requires band-removal antennas and a different style of band than the company’s typical applications. He added that many facilities find the cost of such features prohibitive. Adding it would take the cost of a 10-door system from the $10,000-to-$50,000 range all the way up to $100,000 to $150,000, he said. But he noted that the regular tags can not just be ripped off. Removing them requires a scissors. “Alzheimer’s and dementia patients should not have access to sharp objects,” he added.

Speaking of cost, Konicek said the company sees a wide variety of budgets and timeframe requirements from customers. “We can see our sales cycle at times go up to a year and a half, with new construction of a very large system with 60 to 70 doors. On the other hand, we might have someone call and want a two-door basic system installed the next day because they are being fined $10,000 per day by the AHJ [Authority Having Jurisdiction] for an elopement issue that occurred.”

Scalability

Most vendors have several models ranging from plain vanilla to feature-rich options. Mike Webster, Stanley Healthcare’s senior solutions manager, said that many smaller customers are just looking at two doors and a stand-alone system for safety and security. “What they should be asking is whether that system they are deploying in that stand-alone scenario today is expandable to a larger environment. Can they scale up?”

Stanley Healthcare’s security and communications solutions, including its RoamAlert wander management system, are all integrated into a common event management and notification platform, Webster said. The key to scalability, he added, is having an entry-level stand-alone solution smart enough that it can be integrated into a larger system later. “That is where some solutions are missing the mark,” he said. “Some have to replace everything to move up to a more sophisticated product. We have specifically designed our systems to be backwards compatible. All the intelligence and capability leading to the more sophisticated solution set is in our base offering. It would just be activated once it was part of the integrated system.”

Real-Time Locating Systems

Al Larose, executive vice president at Secure Care, said its ENVisionIT real-time locating system (RTLS) product line addresses several issue that facilities are facing with monitoring residents and workflow processes.

“Many long-term care facilities are starting to offer more and more clinical capabilities. We can help enable things like automated billing, for example,” he said. If a resident goes for physical therapy, the system can be configured in such a way that as soon as a resident enters a room, they are associated with that physical therapist and they are on the clock in terms of billing. When they leave the room, they are off the clock and off the billable hour. “So we help the facility enable an automated billing scenario. Right now, that is a huge problem for administrators because it is all clipboards and pens and trying to keep it straight in a very busy environment,” Larose said.

Another potential use is for keeping residents safe: In certain cases there can be concern about one resident entering another resident’s room and causing that resident harm. The ENVisionIT system has the capability to know when a resident who is a “watch case” enters any other resident’s room or a specific resident’s room that has historically been a problem. It immediately alerts a staff member when that occurs, so the staff can respond, Larose said.

The RTLS nodes are located much like access points in a wi-fi system. Even if there is not hardware in resident rooms, the system can locate them, plus or minus a foot, Larose said. Facilities could set up notices that Mr. Jones hasn’t been to the dining room in eight hours or hasn’t been to the restroom in eight hours. “Our system can discern that and create an alarm or alert through our mVision app,” Larose said. “The staff members proactively know when this is occurring and they can take action.”

The use of analytics

Webster said Stanley Healthcare’s more advanced customers are now creating common data repositories, so data from different systems can be used to help plan smarter, more efficient staffing schedules and care plans for individuals. “They can monitor the activities of daily living and push all that data to a data warehouse in the cloud and use data analytics and customized dashboards to provide a facility operator smart tools that rely on all these technology tags, bracelets and pendants to assist them—and not just for alarm monitoring. They can pull out useful data and use data visualization tools to help them better monitor their facility and care of their residents.”

Even small independent homes make a big mistake if they are not looking at the data aspect, said Steve Elder, Stanley Healthcare’s senior marketing manager. The Centers for Medicare & Medicaid Services (CMS) has released new guidelines for all seeking CMS reimbursement for skilled nursing care, and one of the things they need to document is compliance, ethics programs, quality assurance and key performance indicators of how they are measuring and improving quality. “You can’t do any of those things if you don’t have data,” Elder said. “Having some stand-alone thing at the door that just beeps when someone goes near? I’m sorry. That just doesn’t cut it anymore. It doesn’t document what happened. It doesn’t show how you are tailoring a program for that specific resident. It’s so 20 years ago. They have really got to get out of that mindset. It is not acceptable anymore.”

Philadelphia-based David Raths is senior contributing editor for Long-Term Living's sister-brand, Healthcare Informatics. He can be reached at draths@mac.com.