Simply drawing a breath could be torture for 73-year-old Beverly S., a resident of an assisted living facility in North Carolina. A lifelong smoker, she was, although ambulatory, totally dependent on bottled oxygen. When the concentrator she had in her room malfunctioned, she frantically pressed a button on a pendant she wore around her neck. Within moments an attendant was on the scene and the concentrator was reset.

Mike and Michelle were both in their early 70s, healthy and very active. Well-set financially, they lived in a single-family retirement community on the Gulf Coast of Florida. They were concerned with occurrences of kids from outside the community vandalizing the swimming pool/workout room complex they enjoyed so much. But ever since the fence had been put up around the complex and the card reader installed at the gate, no one had been able to get in and ransack the facility.

Some residents need senior housing managers and their staff to help keep them alive and free from harm. Others merely want someone to take care of the surroundings. Whatever their needs or wants, the residents of senior housing facilities look to the owner/manager to maintain security. And in turn, today's owners/managers of senior housing are using both human capital and the latest in technology to maintain useful emergency call, resident wandering, smoke/fire and life safety systems for their residents.

INDUSTRY PERSPECTIVES "One of the most attractive features of assisted living, for both residents and their families, is the security of knowing that if an emergency arises, there is a system in place that allows for an immediate response," says David Schless, executive director of the American Seniors Housing Association (ASHA), based in Washington, D.C. ASHA directs its attention to legislation and regulatory issues facing the nation's senior housing industry, where state-level laws vary widely.

Senior housing companies are paying close attention to resident security and safety issues for a couple of reasons, according to Christopher Coates, CEO of Brentwood, Tenn.-based American Retirement Corp., a national operator of senior residential facilities. "Our first concern is always for the well-being of the resident," he notes. A more pragmatic concern ranks a near second, though. "Any prudent operator in today's market," adds Coates, "has to be giving at least some consideration to the liability issues that can arise with any kind of emergency that occurs in their facilities."

Safety and security are not just technological issues, either, in today's senior housing industry, according to William E. Colson, CEO of Holiday Retirement Corp., a Salem, Ore.-based owner and operator of 24,000 units in the United States and some 50,000 units in Europe. "The human factor is the most important thing in our business," he says. Holiday Retirement Corp. facilities typically have two sets of live-in managers in each building of its communities, Colson reports. "They (the managers) run the facilities like they own them - they live there 24 hours a day and they lock the place up at night."

GENERAL CONSIDERATIONS In using technology to ensure security in today's senior housing community, "It is important to customize systems to demographics," says Scott Scutt, CEO of Southern Security, a Ft. Lauderdale, Fla.-based consultant providing security products and knowledge to communities of varying age profiles.

The typical resident of a senior housing community wants ease of use when it comes to security technology, according to Scutt. In the senior housing milieu, this means "nothing really all that high-tech," he notes. Two-way voice communication/intercom systems linking resident rooms and nursing/attendant stations, simple proximity devices in the form of collars or wristbands to help track the wandering resident, bathroom pull cords and simple push-button resident check-in systems are all common, says Scutt.

Scutt's firm uses a computerized, Windows-based system made by California-based Sentex as the "brains" of its access control technology. "We have set it up where a bar code on a car windshield decal is scanned by a proximity reader," he explains. Use of this system enables community managers to keep track of who is entering/leaving and to alter the list of those authorized to enter if a decal is lost or stolen.

Ease of use is also a hallmark of the tele-entry technology that allows individual residents to control access to their communities. "If a guest wants to see Ms. Smith, for example," explains Scutt, "they drive up to a tele-entry device at the gate, which is basically a phone with a LCD screen." By punching in the first few letters of her last name or her phone number, the guest calls Ms. Smith on the phone; if she wishes to see the guest, she punches in a three-digit code on her telephone that causes the gate to open.

In an enhancement to this system, images of waiting guests can be picked up by a camera and transmitted to a resident's television via the cable system, adds Scutt. "The camera is made a channel on the cable television system in the community," he explains, so if a resident doesn't recognize the voice on the phone they can turn to a channel on the TV and see exactly who is talking.

"Today's technology should be used to enhance a person's life - not intrude upon it," concurs Timothy Jonathan, president of Concord, Calif.-based PROTECT Emergency Response Systems Inc. For the retirement community owner/manager, simplicity in security and safety systems enhances not only life, but can also impact a facility's bottom line.

"One trend that is becoming more pronounced in the retirement housing industry is the integration of life safety systems," according to Jonathan. In the relatively short history of the industry, "Emergency call, resident wandering, smoke/fire monitoring, access control and delayed-egress systems have all been treated like separate entities," he notes. More and more, though, he adds, developers of retirement housing are looking for integrated packages.

The installation of a relatively simple delayed-egress door with an alarm is an example that illustrates the need for system integration. "Typically, the developer gets a general contractor, who gets an electrician for wiring this and other systems, while a finish carpenter installs the door hardware itself," explains Jonathan. "If something goes wrong in operation, you wind up with 14 different people pointing the finger at each other." Integrated packages, he adds, provide all the benefits associated with a single point of contact for installation and service.

HARD-WIRED PRODUCT IN ACTION American Retirement Corp. (ARC), utilizes an emergency call system manufactured by Daytona Beach, Fla.-based Tel-Tron Technologies, reports ARC senior director of asset management Rock Raessler. The system is microprocessor-based with a computer interface to allow reporting capabilities, notes Tel-Tron's Rick Taylor. The system, typically installed in an assisted living resident's room, includes an emergency call pull-cord, resident check-in button and a smoke detector.

"The pull-cord is located in the bath or bedroom, and the resident pulls the cord when he/she feels in an emergency situation," explains Raessler. When the cord is pulled, or a button pushed on an optional pendant worn around a resident's neck or wrist, a program is activated at a central computer system with a terminal located in either the nursing or reception areas, or both. "A screen comes up," he continues, "that includes the resident name, room, doctor and next-of-kin phone numbers, and things a paramedic may need to know about, such as if they are diabetic or allergic to a particular medication." Not only does the system make emergency call response quicker and more effective, notes Raessler, it also allows us - from a management standpoint - to run reports and determine who is making the emergency calls when and how quickly they get response.

A Tel-Tron resident check-in feature is also used to monitor residents daily. "Once a day, typically in the morning, a resident sees a blinking light in their room, and they push it," says Raessler. "In this fashion they are checked-in, and the staff knows that they are alive and well." The Tel-Tron system prints out a daily report, he adds, and should the resident fail to press the light unit, a staff person gets on the phone to personally check up on them.

One of the most important aspects of the Tel-Tron system, according to Raessler, is the fact that the central computer station does not need to be constantly manned to handle emergency notifications. "Our system is set up with a Motorola 'people finder,'" he says. "Emergency messages that come into the computer are sent through the people finder and on to alphanumeric pagers carried by staff members," says Raessler.

HARD-WIRED VS. WIRELESS Tel-Tron is a "hard-wired" system, which in Raessler's eyes is preferable to its wireless counterparts. The good thing about a hard-wired system is that it continually diagnoses itself, says Raessler. "In the event a wire breaks or malfunctions in a hard-wired system," he notes, "the computer notifies us immediately."

Wireless systems do have their advantages, though. Tucson, Ariz.-based Fountains Retirement Communities uses the wireless PROTECT in many of its campus style CCRCs, according to company CEO David J. Freshwater. "We use PROTECT particularly when we are doing a retrofit or renovation of an existing facility," he says, "while we go with hard-wired systems in most new construction situations."

WIRELESS IN ACTION The wireless PROTECT Emergency Response System utilizes fixed transmitters that are typically located in a resident's bathroom, "where the majority of resident emergencies occur," says Jonathan. "Residents can also carry transmitters on pendants, providing coverage both in their individual units and throughout their communities."

Daily resident check-in is accomplished in a unique fashion by the PROTECT system, adds Jonathan. "We don't use a push-button device," he notes. "Many residents will, for whatever reason, fail to push the button, which results in a lot of staff time involved in trying to track people down."

Instead, PROTECT utilizes a passive infrared motion detector (PIR) in the resident room. Located in the bedroom or the hallway to the bath, the PIR detects motion within the room and checks in with a central computer. If the PIR is not tripped by some motion in the room within any 12- to 24-hour time period, adjustable by the management, an alarm goes off at the central monitoring console to alert the staff.

SPECIAL RESIDENTS The security of residents suffering from Alzheimer's disease and other cognitive impairment/dementia requires that managers take special measures. At American Retirement Corp. facilities, for example, "We do not put either emergency call or nurse-call systems inside our memory impaired units," says Raessler. "These areas are heavily staffed to begin with, the facilities are smaller, and there is a more constant level of interaction between residents and staff," he notes, "Our feeling is that a truly demented person does not typically have enough cognitive awareness to pull a cord or push a button."

One common behavior among senior housing residents suffering from Alzheimer's disease or other forms of cognitive impairment/dementia is wandering. A variety of methods are used to control this, providing safety and security without compromising dignity or comfort.

ARC uses Tel-Tron products to secure the doors and windows of its memory impaired units. Doors in these units require a punched-in code on an adjacent Tel-Tron keypad for their magnetic locks to open, according to Raessler. In states where locking in patients runs afoul of fire safety codes, delayed-egress hardware, requiring steady pushing on a panic bar for the door to open, is used. "In some states, we have to post a sign that says 'Push this panic bar for 15 seconds to open the door,'" he explains, "Pressure will build, and at the end of 15 seconds, an alarm will go off and Tel-Tron will let us know the door is open."

A basic technology is the use of heavily secured environments. "In Europe, Alzheimer's patients typically get a much heavier level of care than in the U.S.," says Colson, "and the use of lockdown wards is widespread." Closer to home, says John Luciani III, executive director of Boca Raton, Fla.-based Grand Court Lifestyles Inc., "The facilities we have that are licensed to accept Alzheimer's and dementia patients are locked and heavily monitored 24 hours per day so that there is no way patients can leave without being accompanied by staff."

Emeritus Corp. and Fountains Retirement Communities have used the WanderGuard Departure Alert System, manufactured by Lincoln, Neb.-based Senior Technologies Inc., to help control wandering. According to the Senior Technologies site on the World WideWeb (http://seniortechnologies.com/wanderguard/ index.html), "A wristband signaling device is placed on the dominant wrist of a resident that might present a wandering risk." When that person moves close to a door monitored by WanderGuard equipment, the system picks up a signal generated by the wristband device. If the resident opens the door, the alarm sounds; if the door is also equipped with magnetic locks, they are engaged.

THE FUTURE Baby-boomers who will be hitting their retirement years in the early- to mid-2000s will benefit from at least two technologies that are in their formative stages today.

One of these technologies is home automation, according to Scutt. Probably of most benefit to those seniors able to enjoy independent living, this technology utilizes systems that automatically turn on/off alarms and appliances, heat water and control the use of other utilities to best conserve energy and cut costs, and turn on/off lawn sprinklers as needed. Software manufacturers currently active in this area, he notes, include Framingham, Mass.-based Savoy Software, with their Windows-based "CyberHouse" package.

Another technology is off-site monitoring of senior housing communities, which is one useful application of RemoteWatch Pro. This system is composed of a personal computer-based video transmission and digital recording system manufactured by California-based Alpha Systems Lab (ASL) Inc. With this system, children can place a camera in their parents' room in a senior housing community and access images through the Internet, says ASL's Jim Pierce.

New technologies such as computer monitoring programs, like this one from Alpha Systems Lab, help ensure quick, effective response.