A Panel of Experts On: Safety and Security

Keeping residents safe and sound is an issue that concerns all assisted-living providers, as well as the residents and their families. But how can a provider make sure they're taking all necessary precautions?

We turned to a panel of experts to answer several poignant questions regarding safety and security. Thanks to members of this panel, many residents are kept safe and sound. Here's what they had to say ...

Can you provide us with some specific examples of situations where safety or security features and/or products proved their value in a senior-living environment?

Brash: We worked with a man named Tom, who had Lou Gehrig's disease and was living with his wife. He was continuing to decline, but did not want to prevent his wife from leading a normal life. He carried a pendant with him all the time so if she was gone and he ever fell and was unable to get up, he could use the pendant to alert her. It gave him added security and his wife added freedom.

Another woman I know, Harriet, had severe back problems, and she had great difficulty walking without a walker. She maintained her independence in her own residence for three years by carrying a pendant always with her, so if she fell, she could call for help. She never did fall, but the key thing is that she could live autonomously because she had this ability to seek help if she needed it.

Dronek: We worked with a facility that found its residents kept getting their hands caught in the open end of a handrail return. To provide safer support for these residents, we engineered a unique cover for this specific area of the handrail. Residents were no longer at harm.

Artis: An example would be like the "I've fallen and can't get up" commercial. Most of the examples are results from falling down and assistance needed in getting out of a chair.

O'Reilly: It happens all the time that someone has a heart attack and a wireless system saved their life. The most significant examples I can remember are strokes. If a stroke patient has a remote system and can get help immediately, rather than waiting for someone to find them, they'll be extremely thankful that they've had this device, because the sooner they can get help, the less likely they'll suffer from permanent damage.

Green: My story is that of a system that didn't work, and therefore was not a true life safety device. My wife had a friend, an elderly man, who'd had a heart attack. He had a pull-cord system, but when he pulled the cord, apparently it didn't work. They found him the next day. That's why it's important to find a system that works 100 percent of the time. You must test for backup and compatibility, and make sure it will always work.

Gulati: Security proves its value every day in every assisted-living facility in the country. When a resident falls, statistics show that the sooner that resident achieves assistance, the better their prognosis for recovery. Wearing a wireless transmitter to summon help immediately, or having automatic fall detection, will save lives. As residents age in place, operators need to address the increased frailty of their populations.

Two stories stand out in our minds and prompted owners/operators to install a wireless system. In the first, a woman fell in the middle of her bedroom. She lay on the floor all night with a broken hip. She could not reach the pull-cord on the wall. When she was found the next day, valuable time that might have given her a chance for recovery had been lost. In another example, a woman couldn't get herself out of the bathtub. She lay all night in the cool water because she couldn't reach the pull-cord. This would have been an easy situation to rectify had she been wearing a wireless transmitter.

What would you consider to be the most important safety and/or security features to include in a senior-living environment?

Dronek: One of the biggest challenges facing the global healthcare industry today is addressing the safety needs of such a diverse and growing resident population under a facility's financial constraints. Owners/operators must work with vendors to find the best quality for safe environments for residents.

O'Reilly: Of course, they need a fire-alarm system, and they need to maintain their buildings. That aside, there is a curious contradiction that keeps cropping up in my discussions with administrators and others in the retirement community business. When asked about making their existing emergency system more accessible to the resident (usually a pull-cord system is what is offered), the remarks commonly heard are similar to: "Our residents are active and independent. They don't need that." My question to the home is, "Why do you have a system?" Their answer is usually, "Just in case they need help." To that, I would say, "Well, do you believe that if and when they need this 'help' they will always be near the pull-cord?"

The reality is that the active folks are the people who fall most often because they take more chances and move faster. In this business, we find that in almost every case, they are not near the pull-cord and spend protracted periods of time on the floor or in the shower/bath waiting for someone to "miss" them.

Gulati: First of all, owners want a reliable emergency call system that is cost-effective to install, easy to use, and enhances the efficient management of their facilities. They want their residents to have a personal transmitter (wrist or pendant) with them at all times so that they can get help from anywhere in the facility.

Owners want to be able to quickly identify the resident sending the alarm and the location of the resident when the alarm was sent. They want to be able to track response times (how long it takes a caregiver to respond to an alarm), and they want the ability to analyze and collate information, and print management reports. The emergency call system they choose should help owners and operators manage their facility efficiently.

Jonathan: The No. 1 concern for most operators is resident safety. The major problem is, how do you keep the resident safe while maintaining the residential atmosphere of the community? Most operators are including an emergency call system in their communities--including pendant transmitters. Some install resident-wandering systems. Residents with some level of dementia wear a transmitter to signal if they leave the community. Delayed egress, electromagnetic locks are typically used in the dementia areas, although delayed egress locks can be used on doors in independent living and assisted living, too.

Artis: I think it's got to be hardware. With wireless there's room for error; you don't get 100 percent coverage. A wireless device can cut out on you.

Green: They need a system that works all of the time, 100 percent. Residents and developers may feel they have a true life-safety system that will work, but it may not. Batteries can die, etc. In an emergency call, a lot of systems were designed for hospitals, where a call will come in from the resident to a central console, and a attendant is required to be there to answer the call and summon for help. In assisted living, though, they've driven the staffing levels down so low that they don't want dedicated personnel standing at a central console. So really, the calls should be able to be retrieved anywhere an attendant happens to be in a facility. This requires a de-centralized system.

Rheaume: It's minimizing risk-liability. People can come in or out of the facility, and the alarm will trigger. It's so important to be able to have a feature that you can count on, to actually locate the area the person is in.

Helstrom: There are two aspects to security, and one is the resident. Owners want some way to allow residents to create an alarm whenever they need help. And that method has to be wireless. That's the way the whole industry is going.

The second aspect is the building itself, an unexpected or unplanned departure or entrance to the building. The reality is that the owner is more concerned about people leaving the facility than coming in. You sometimes have people with early dementia who have not been identified as persons at risk. As a consequence, if the door opens at 2 a.m., the facility needs to know that.

Operators want something that will tell them when the exterior doors are opening and closing at off hours. They want something the resident can push regardless of where they are in the facility that will tell them who has pushed their alarm and where they are. And thirdly, they want some way of monitoring the degree of reaction time of the staff to calls. The owner wants to know what kind of care is being given to his residents.

Chartrand: The most important security feature is reliability, making sure when a pendant is pressed it gets through to sound the alarm.

Brash: I should focus on two areas here: wanderer security and call systems or patient-alert systems. The first thing is it's important that owners have a good call system that allows the resident to use it in locations other than their bed or in the bathroom, more specifically, a pendant that can travel with the patient. Secondly, it's important they have some type of plan for how they will monitor disoriented people who are departure risks.

Call systems now provide for residents to be mobile. Our system, the Arial system, for example, has the ability to identify where people are if they're away from their room when they call. They need to be within a defined environment, but they no longer need to be in their room.

Wilowski: Often, when a senior falls, they can't get to their call station. A wireless product enables them to call for help without having to reach the pull cord. Facilities need wireless technology, but it's good to have the hardwired back-up, too, because not everyone will carry one of these pendants around.

Coulling: Flexibility and wide-range product line are the most important features from the owner operator standpoint because you want to make a product available for people who have different needs.

What's new in the safety/security arena in terms of features and/or products?

Johnathan: Our newest innovation was developed with the help of one our major regional developers. We place motion sensors in the dementia/Alzheimer's residential units to alert staff if a resident is out of bed at night. Often, residents forget they need a walker to stand, for example, and attempt to get out of bed, but fall. The motion sensor tells staff that the resident has tried to get out of bed, so the staff person can go and check on the resident's status.

Dronek: More facilities are designing their interiors so residents can safely and independently move around. For instance, there is a unique handrail that is beneficial for both pedestrian and wheelchair traffic, called the 2000 Handrail, designed with the help of one of the leading authorities on Alzheimer's design, Betsy Brawley. It's wide gripping area helps those with arthritic or weak hands as well as other users.

Another example is the way-finding design. Many facilities have color-coded their hallways so that residents can easily find their way to and from their rooms by associating the appropriate color.

Artis: The newest item in the security arena is telephony. Telephony has been around a while, but it's now integrated with all three systems, and it can go on a wristband, in a room or head-end, a nurse's station.

Gulati: More assisted-living communities are installing wireless emergency call systems. The Fidelity TeleAlarm wireless NurseCall system now offers the ability to not only identify the resident-in-need, but also locate that resident in the building. The company also offers supervised transmitters that log in several times daily to check functionality.

Complete facility coverage with in-room voice communication between resident and caregiver and wireless coverage of common areas, elevators, pools and stairways is now possible. Fidelity TeleAlarm offers this capability by integrating its in-room VoiceResponse™ and wireless NurseCall systems.

Fidelity TeleAlarm is constantly developing improved transmitters, making them smaller, more stylish and less conspicuous, and having them automatically supervise functionality. On-site battery replacement saves time and money. Another innovative transmitter feature is automatic fall detection. Transmitters with this feature will send an automatic alarm when a resident falls, without the need for the resident to press a button.

Rheaume: New security features like advanced wandering resident systems are great. We offer the ankle transmitter, which is our newest feature. It can show who a resident is and where the person is located.

Brash: If you do lock a door that's a fire exit, the fire marshal will object, unless an FPA101-compliant lock is used. These locks have to be wired back to the fire panel, and they have to allow for what is called "delayed egress," which means if someone tries to exit the door, it will go into an alarm mode and release 15 seconds later. It's allowable on those doors to have an optional three-second delay, which means that a wanderer could go up and try the door, and if they don't continue to push on the door for three seconds continually, they will not set off the alarm and the door stays locked.

O'Reilly: The software and technology available to be able to know where your residents are at all times. You can monitor them, but you don't have to be constantly checking on them. The systems themselves have built-in checks. It gives the residents more security. It's good for the community, good for the residents and good for their families. For the owner/operator standpoint, then, it's a good marketing tool.

Our system (Centrol), offers conversions. We do retrofitting of existing systems, which is very economical for communities that have existing systems. And we also do full-blown systems for new construction.

We make devices to give residents freedom. I met a woman who said she felt like she'd been tied to the button at the side of her bed. She said it was like having a six-foot leash. But she was afraid that if she took it off and she fell, nobody would help her for awhile. Now she's still connected without the wiring--because of wireless transmission.

Chartrand: Software is the new measure of security-how effective it is. This new platform, Windows NT 95/98, upgrades the system so that there are nurse stations with the security.

Helstrom: New things in the industry? The ability to locate people within a facility. New features attached to wandering systems.

We have a temperature sensor in the bottom of the tag each resident wears, so we're constantly monitoring the skin temperature of the individual, minus some change because it's going through the plastic. If you take that tag off, we will know about it within seconds from the temperature change.

Coulling: Software is the newest item, especially Comdial's own Avalon software program. The software pinpoints and targets the location of the individual/problem.

What are the most important questions to ask when selecting a safety/security vendor?

Wilowski: Get references. Find out how long they've been in business.

O'Reilly: Definitely ask for references and names of people using the system. More than anything else, I'd rely on reputation. And, pricing is an important consideration when selecting a product from a vendor. Once you are satisfied that the product you are considering is the latest technology and has good references, bear in mind that emergency call systems have a broad price range. Just because it costs more doesn't necessarily mean the product is any better.

Artis: People should ask if the system is supervised. We make every effort to ensure that the engineering staff checks the system, to see if the system is checking itself.

Helstrom: You want to know how long they've been in business and who their major customers are. Check to see if there's ever been any law suits against them. You really need to talk to references. There is a big difference between the different ways people sell these systems. You need to find a vendor who is honest about the options that are available and the kind of features. The owner has the best idea of what he wants for his residents. When I'm talking to a new customer, I spend more time listening to what they're looking for than telling them what I can provide.

You need to look for people who have a national presence, who have been in business for more than five years, and who have good references or are dealing with major vendors. You should probably talk to at least two or three.

Chartrand: You should always ask and make sure that the company has the ability to meet all of the person's needs, offering a "total solution" and capability of providing after-sales service.

Green: Look for a track record and request a full demonstration of the equipment before buying it. From the local vendor, I'd want a very short response time if there is a problem--maybe a 15-minute response time.

Rheaume: People need to ask the vendor if it is local. You don't want to have to send items back to people, and you want to take into consideration geography and legislature. You need to look at the distance, the quick availability of service and if there are new changes in store.

Gulati: They should consider the needs of the resident and the needs of the caregivers. They should also ask the vendor's commitment to research and development of new and improved products, so they can purchase a modern system flexible enough to integrate additional features as residents' needs change or new products are introduced. Owners should determine if the vendor manufactures its products, and if these products are being used as originally designed, not modified off-the-shelf wireless security products being marketed to our industry but not offering the level of security, reliability and quality necessary for this market.

An owner should ask if the vendor's products meet or surpass industry standards and state regulations. They should request supply references of facilities that use the system, as well as request financial references and reports to determine the vendor's financial health. How long has the vendor been in business? How many installations has the vendor completed? Who will service the system? How fast can the facility expect to receive service? Does the vendor offer local service? Does the company offer a service agreement? What does the warranty cover?

Finally, they should ask the vendor to describe the advantages of his system over other systems on the market that the owner may be considering.

Coulling: The most important question to ask the vendor is do you offer flexibility, the wide-variety approach, and can the company provide 24-hour, seven-day a week service?

Is there anything else that should be addressed?

Wilowski: Vigilance is important. You have to have enough trained, competent staff to keep a good eye on everybody, to know what each resident needs, what the risks are and evaluate them. I think exercise is important--you've got to keep your residents strong and active, and they'll be less likely to fall (prevention). And if they do fall, they've got to have a way to get help quickly.

Johnathan: Can the vendor integrate all the safety systems into one comprehensive package? The PROTECT One System, for example, integrates all the life-safety systems-emergency call, fire, resident wandering, delayed egress-and security into one package. All systems' alarms are primarily or secondarily monitored by the PROTECT computer. This way, all alarms are sent to staff, and defined, so staff can deal quickly to all emergencies. If various systems are not integrated, their effectiveness is greatly diminished.

Artis: We've come up with a product that's perfectly capable of meeting the needs of customers and residents in the community. The secret to emergency security is to offer flexibility, options and different choices.

Chartrand: It's having the capability of accurately pinpointing the location of a problem because it keeps the location up-to-date and upgrades security.

Brash: The buyer really needs to be looking for a company that gives some reasonable assurance that it's durable, that it's going to be around five years from now. There are no absolute guarantees in this world, but certainly there are companies that have a history of being leaders in their field. I think that would be important to somebody making a purchase.

Dronek: In today's healthcare industry, complete with financial turmoil and high turnover, it may be easy to overlook a few safety details. However, as resident populations grow, safe environments become even more vital. All healthcare industry owners, operators and vendors need to understand and realize this. By realizing this need and working together, residents will receive the best, most innovative products and features for a safe, healthy environment.

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