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Striving to Achieve Aging in Place

February 1, 2002
by root
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An Interview with Lydia Lundberg, Co-Owner, Elite Care
American seniors are not "stuck in their ways"; they are simply comfortable with the familiar. And when they face the prospect of declining health, it's only natural for them to want to remain in familiar environments to live out their golden years. Allowing residents to "age in place" isn't always easy, though (ask any assisted living provider). Bill Reed and Lydia Lundberg, the husband/wife team behind Elite Care of Milwaukie, Oregon, think they have found the answer in Oatfield Estates. Their community of three small (about 12-resident) homes with live-in caregivers employs technology and design elements aimed at meeting their residents' needs-both current and future.

To learn more about how their residents age in place and what they view as "an alternative to assisted living," Nursing Homes/Long Term Care Management Assistant Editor Douglas J. Edwards recently talked with Ms. Lundberg.

Edwards: How do you use technology to help seniors age in place at Oatfield Estates?

Lundberg: Although I could list many technologies, our first was the development of the location badge, which everyone wears. If a resident calls for help, the computer notifies the caregiver and signals where that resident is. This will also tell us how fast the call was answered and who responded to it.

The badges are both IR (infrared) and RF (radio frequency). In order to get a location indoors, we have to use IR, as the IR signal does not travel through walls. RF is used outdoors, where IR wouldn't work. Each room has one or more IR sensors in it. Every time someone with a badge walks into a room, the sensor sends a signal to a programmable logic controller (PLC). Also, each badge has a unique ID. This is how the computer will know who is calling for help where.

We also place weight sensors under residents' beds, with their permission, of course. The weight sensors are located under the posts of all four corners of the bed. They are strain gauges, with an accumulation unit. The weight is averaged and the signal is sent to the PLC. These tell us if residents are gaining or losing weight, restless in bed or getting up a lot during the night. With this information we generate graphs to identify trends in residents' behavior, potential pain issues and even urinary tract infections (UTIs). It is not unusual to develop scheduled toileting programs for incontinence based on these data.

The weight sensors are hardwired, the PLC is hardwired and so are the computers. The only wireless connections we are using at this time are the badges to the sensors. We chose this method to handle signals at a very high speed; it is reliable and cost-effective.

Another electronic development has enhanced the life of those with dementia. As people develop symptoms of dementia, they might wander more at night, so we have a system that sends e-mail to the phone of the caregiver on duty when the resident gets out of bed. If the resident leaves his room, he trips a light beam, which sends a second e-mail to the phone. This will let the caregiver know to start looking for the resident.

Our in-house programmers are in the process of writing the software so that a resident's badge unlocks only the door to his room. Caregivers, who also wear badges, are allowed to enter any room. It's like an electronic key and extremely easy to use, with or without dementia.

Other things on our drawing board (to be initiated within three months) are electronic cues. For example, if residents have a pattern of getting up to use the bathroom at 3 a.m., but begin to forget to do so, and consequently have incontinence episodes, their bedroom lights will come on automatically at the proper time to remind them that it's time to go to the bathroom. This would be programmed in the computer; the PLC would turn on the light at the appropriate time. All lights, fans, switches are wired back to the PLC and, therefore, can be operated remotely, as well as manually.

Edwards: Aside from the technology, how does the design of your homes facilitate aging in place?

Lundberg: We designed our homes quite differently from the traditional assisted living facility we've seen that has long hallways, few common areas, and amenities that are hard to use. These types of designs make it uninviting for residents to venture out into the common areas as they become more frail. Residential homes do not have long hallways. Neither do ours. Each home has about 11,000 square feet and three floors, serviced by an elevator. The caregiver suites are located on the lower level. The first floor has a living room surrounded by six suites. On the second floor is a big residential-style (resident-use) kitchen with a dining area and a family room that is also surrounded by six suites. We did this so residents could very quickly move from their rooms to a common area. We've also incorporated all the wiring into the design for future needs.

Edwards: How do you provide for residents aging in place to the extent that their health declines and they need advanced medical care, such as that typical- ly provided in a skilled nursing facility?