Providing a Safe Harbor:
What Senior Living Communities Need for True Security
By Kelli M. Donley
 When the words
"security" and "senior" are linked in one sentence, the
commercial cliché of a woman who has fallen and is calling for assistance
immediately comes to mind. Yet, senior living communities must consider a broad
spectrum of potential situations to ensure the safety of their residents,
employees and facility.
Residents
A senior living community, by design, is supposed to provide an asylum for
seniors -- an area where they can live comfortably without the threatening
worries of the outside world. Personal safety is of utmost concern.
In the book, "Falls in Older Persons: Prevention and Management,"
author Rein Tideiksaar, PhD, writes, "One of the most common and often
critical problems faced by institutionally based healthcare providers is that of
falls among older adults. Hospital falls represent a leading cause of adverse
events, accounting for 25 to 89 percent of all reported inpatient incidents.
People age 65 and older experience the majority of these falls. In the nursing
facility -- a setting older people are admitted to often for safety reasons --
falling is equally problematic. More than 50 percent of all nursing facility
residents fall each year, and more than 40 percent experience recurrent
episodes."
Tideiksaar goes on to describe how senior living administrators can learn why
falls happen and several methods of prevention. While medical strategies include
a clinician identifying acute problems and possible imbalance caused by
prescriptions, rehabilitative methods use exercises to aid in strength.
Environmental changes that can prevent resident falls include adding lighting,
selecting flooring that is slip-resistant, installing handrails and providing
furniture ergonomically designed for seniors.
To assess whether a resident is prone to falls, staff should ask the person
to do a variety of movements, including but not limited to the following, to
determine if they can be accomplished independently:
- Chair transfers
- Sitting
- Rising
- Standing balanced
- Bed transfers
- Toilet transfers
Staff should also know if a resident has fallen in the past, has visual
impairment, cognitive impairment, arthritis or if he or she is taking
medications.1
One of the forefront safety concerns for residents who have a form of
dementia is the possibility they could wander away from a community.
In "Challenging Behaviors in Dementia," authors Ellen Mahoney,
Ladislav Volicer and Ann Hurley discuss strategies to prevent several behaviors,
including wandering.
"The exact prevalence of elopement in people with dementia is
unknown," they write. "Wandering (presumably unattended and not
permitted by caregivers) occurs in up to 65 percent of nursing facility
residents and dementia clinic patients and 36 percent of people with dementia
living in the community."2
Besides installing advanced security monitors and wandering prevention
mechanisms, Mahoney suggests a walking program may give residents the exercise
and time outdoors they could be looking for when attempting to leave a
community.
"The primary caregiver goal is to prevent elopement and interference
with other residents by providing safe outlets for the urge to walk. Successful
management of primary and secondary dementia symptoms and precipitants to
elopement is the second line of prevention. Treatment of all underlying causes
of challenging behaviors should begin with a comprehensive assessment to
identify the potential causes so that interventions can be directed to the root
cause of the behavior."2
Employees
While security measures in senior living communities can prevent residents
from wandering and intruders from entering, they can also be prohibitive to the
movements of staff members.
Officials at Wen Extended Care Facilities Management Corp. found this to be
the case in the nursing homes they operate in the New York City area. With more
than 1,300 employees who speak a variety of languages, officials needed a system
that allowed staff access but prevented a breach of resident security.
Their solution is high tech -- the HandReader system, manufactured by
Automated Time Concepts. Since 1998, 14 of the systems have been installed in
the three Wen Extended care facilities.
"The HandReaders work well for us," says Joseph Malone, Wen's
controller. "We've had no false accepts and that's great. Employees need to
get in and out quickly or they lose confidence in the system. It doesn't take a
fingerprint, which would have been very unpopular and caused the union to flip
out. When we had cards and badges, people were always losing them or saying
they'd lost them."
The system tracks the number of employees entering and exiting.
Intruders can be a threat to any facility but should be taken more seriously
in a situation where residents may not be able to move quickly or get to a
telephone.
Administrators at the Laredo Housing Authority-Senior Citizens Home were
receiving complaints from both employees and residents after a series of
break-ins. The 40-year-old, 100-unit facility was soon equipped with Schlage
Computer-Managed locks, Locknetics magnetic locks and touchbars and LockLink
Express software.
The choice of this security system was important to administrators because of
its simplicity.
"We selected this system because it allows our residents to use an
iButton credential to obtain entry into the new exterior gate lock, the grounds,
all common areas and their rooms," says Rodrigo Garza, director of
modernization for the facility. "This is very convenient for the residents
because they only need one credential to access all locks. Our residents touch
the iButton pad to the reader on the lock to gain entrance."
While providing residents with this type of access may raise some eyebrows
concerning providing an opportunity for wandering behavior, Garza says the
technology allows staff to track where and when their residents are going.
"A nice surprise with these locks was that we could actually audit who
has been in what room and when," he says. "This is important for
several reasons, not the least of which is this is a senior citizens' home and
it is important to keep track of the residents."
Facility
The reasons for installing a security system are clear -- prevent falling and
wandering behavior and prevent intruders from entering the building. There are
many companies that specialize in the industry of ensuring security in such
communities.
Jerry J. Johnson, CEO of Cornell Communications, says the Milwaukee-based
company developed emergency call technology to prevent elopement.
"The features of (the 4000 Emergency Call System) include instant
notification to staff that a call for assistance has been made," he says.
"This call is communicated via either a room light indicator at a central
station or as a direct communication to the responsible staff person via a
pocket pager. The staff member is then required to cancel the call from the
origination point, thereby confirming that the resident's needs have been
acknowledged and addressed."
John Schum, vice president of sales for Dynalock, based in Bristol, Conn.,
says the casual use of emergency egress doors is a frequent security problem in
senior living communities.
"Dynalock delayed egress systems are used not only on emergency exit
doors, but on front entrances as well," he says. "These systems
provide time for staff members to retrieve patients who might attempt to leave a
unit and wander into harm's way. It is very common to tie a DynaLock delay
egress system into a separate patient wandering system, thus enhancing the
security of that system."
Joe Whitt, vice president of sales for HomeFree, based in Milwaukee, Wis.,
says wandering behavior is common, but preventable.
"There are three common security breaches at senior living communities
that our technology platform can help control: the removal of transmitter
bracelets and bands, the elopement from a non-monitored door and multiple
elopements," he says.
The company manufactures the Personal Watcher, which notifies staff if a
resident removes a monitoring watch. Their systems' continuous monitoring
feature notifies staff if residents exit windows or a non-monitored exit. Each
resident can be identified in the case of a multiple elopement, as well.
Joe Kopetka, product manager with Stanley-Senior Technologies, based in
Lincoln, Neb., says the company's WanderGuard departure alert system notifies
staff of residents attempting to leave the community before they are able to
exit the door.
"We are the only company that offers electromagnetic interference alarm
notifications," he says. "It has digital processing and engineering,
multiple alarm tones and programmability for numerous custom functions,
including multiple departure alert."
Kopetka agrees that elopement is the most common security breach at senior
living communities.
Environmental Concerns
Administrators should also be concerned about protecting their residents from
environmental risks, such as fire, flooding and natural disasters. According to
the Occupational Safety and Health Administration (OSHA), workplace fires kill
more than 200 people annually and injure more than 5,000. OSHA provides
employers with basic software to make sure facilities are up to date with fire
detection and suppression equipment; this free download is available at: www.osha.gov/dts/osta/oshasoft/softfirex.html.
The American Red Cross (ARC) advises that in the occurrence of a flood or
flash flood warning, administrators should be able to evacuate residents. Vans
should be ready ahead of time to take staff and residents to higher ground
immediately. Additionally, officials recommend a disaster supply kit, including
first aid materials, canned food, clothing and identification, and to be ready
in case the situation arises. The ARC provides similar advice for other natural
disasters that could impact senior living communities at: www.redcross.org/services/disaster/keepsafe/.
Safety and security are intertwined -- meaning freedom, invulnerability and
refuge. Not coincidentally, these are also characteristics of a great senior
living community.
To Protect Residents, Assets, Follow Rescue Assistance Laws
It is an administrator's worst nightmare -- it is the middle of the night and
smoke fills the halls of a multistory senior living community. Disoriented
residents rush toward exits. If the community is prepared, the residents will be
swiftly rescued and taken to a safe location.
If rescue assistance laws have been overlooked, most likely a disaster of
this nature would be fatal. Besides the gravity of losing a resident, rarely can
facilities continue to operate successfully after such an occurrence. Insurance
premiums skyrocket and confidence is lost in the services provided.
Following the American with Disabilities Act (ADA) to the last detail can
give senior living community administrators a necessary safety net. Title III of
the ADA reads: "Areas of rescue assistance are generally required on each
floor, other than the ground floor, of a multistory building. Specific
requirements are provided for such features as location, size, stairway, width
and two-way communication."
While the floor space for an area of rescue assistance is normally available
within stairwells that are compliant to state and local fire codes, the law
requires signage and a method of electronic communication.
This communication guideline recommends more than just an alarm that can be
sounded by a resident in need. A two-way method of communicating with rescue
workers is necessary, including a voice confirmation system and lights for those
residents who are not able to hear.
Dale Austin, with security manufacturers' representative firm C & B Sales
Associates, LLP, says meeting the ADA requirements provide a sense of security
financially as well.
"Some states are enforcing compliance more diligently that others, yet a
building owner can hardly afford to bank on leniency at the local level,"
he says. "Here in Charlotte, N.C., it's the local building inspectors who
seek compliance. There are fines to pay if it is discovered that you don't have
it in. The biggest argument I use when I engineer jobs for customers is, 'You've
got to have it. It's a matter of pay me now or pay me later.'"
Mark Zimmerman, an architect with ZDG of Milwaukee, says holding designers to
the priority of meeting such a building code is essential.
"It's the architect's responsibility to be code-proficient, because
we're the ones who seal and sign the drawings before they go to the local agency
for review," he says. "The fire inspector, or whoever else is
reviewing the plans, identifies that when there are stairs to navigate, there
need to be areas where disabled persons can be secure while emergency personnel
make their way there. So we need to bring this to the building owner's attention
first."
An example of a turnkey rescue assistance system is the Cornell 4200. The
wall-mounted control panel is usually installed on a ground floor near an
entrance where emergency personnel would be able to easily find it. The single
control panel can support 20 rescue assistance areas -- each represented with a
written description of the location within the building. The panel also features
an alarm and a method of two-way communication with the area of rescue
assistance.
JJ Johnson, president of Cornell, Inc., says the ADA law was written to
protect the frequently overlooked.
"The underlying intent of this law is very noble, as it is meant to save
lives," he says. "Imagine a handicapped person trapped in a building
when a fire breaks out. If the elevators aren't safe to use, then that leaves
only the stairs. But if that individual can only get around in a wheelchair,
then obviously they can't get down the fire escape. That person would have to
find a place to wait until someone came to the rescue. There has always been
this terminology of Area of Refuge, as the area around the stairwell, but the
new law added that you now must put in some means for the disabled to
communicate to rescue personnel -- that they are stuck and they need help.
Those who do not follow the law can find themselves in a world of financial
woes.
Section 8.4000 of Title III reads: The Department of Justice may bring a
civil action in any appropriate U.S. district court. The court may award
monetary damages that include all forms of compensatory damages, out-of-pocket
expenses and damages for pain and suffering to individual victims of
discrimination. Also, the court may assess a civil penalty against the covered
entity in an amount not exceeding $50,000 for a first violation and $100,000 for
any subsequent violation.
For additional information, visit: www.cornell.com,
www.usdoj.gov/crt/ada/adahom1.htm.
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