Seniors housing expansion requires product developers to be at the top of their game in protecting the elderly using systems technology and design.

The facts are clear, elderly residents have to be monitored in certain assisted living, skilled nursing and Alzheimer's environments. They can wander off and hurt themselves, or even get lost, if they are not properly monitored within the seniors facility. Today, wanderer monitoring systems are mandatory for a successful long-term care program in most seniors housing facilities. With the demand for many new seniors facilities into the next decade, it's a wide-open field for product development and the competition for market share.

The wanderer monitoring systems used in seniors housing are high-technology at its best; whereas, the marketplace is growing at a rapid rate due to the amount of seniors housing development throughout the nation. There are various types of monitoring systems and they include alert panels, voice alarms, electromagnetic door locks, perimeter alarms, individual identification systems and transmitter alarms. These systems must be effective, comfortable and adaptable to the seniors environment and control the wandering in a more relaxed atmosphere for the residents.

"The devices we're looking at for elopement control would be a device that is worn around the wrist or ankle, where if the patient were to pass one of the electronic receivers it would alert the staff that the patient has entered into a certain part of the facility," says Chris Davis, director of safety and loss prevention for ManorCare Health Services. "We try to create an environment to give our residents the best of both worlds, that it's a kind of free environment to access various parts of the facility. We don't want that institutional feeling where people feel they're locked in a room or locked in a unit, and in order to do that we had to radically rethink how do we create monitoring and security systems that allow people the freedom of access, but yet have a system that's accurate and a very low false alarm rate."

One of the main issues involved with monitoring systems is the training of staff members that work with residents in a seniors environment. The Assisted Living Federation of America (ALFA), a Fairfax, Va.-based association, has developed an entire series on how to work with Alzheimer's patients and included in the series are the monitoring systems utilized with these types of patients. The program is called the Assisted Living Training System (ALTS) and it's the first-ever system of educational tools to address specific training issues in the industry. "Effective training that models the nation's best practices is key to the long-term success of assisted living communities, and essential for raising the professionalism of our industry," says KarenWayne, president and CEO of ALFA. "The learning guide and videos provide caregivers with techniques that will help them care for confused residents. The materials present real-life examples to illustrate the teaching points for communicating with Alzheimer's patients, managing the wandering resident and dealing with agitated residents."

PRODUCT DEVELOPMENT RULES When a wanderer incident occurs, the different types of monitoring systems in a given facility, both visually and audibly, alert staff members to the exact location of the wanderer, for protecting patients is a 24-hour problem. "Wander monitoring systems are oversimplifying, it's a system to prevent people with dementia from leaving a facility, it's to prevent unwanted egress of certain individuals," says Glenn Jonas, president of Code Alert, a Brookfield, Wis.-based manufacturer of wanderer monitoring systems. "The systems are primarily in long-term care, but they're now being used by an increasing amount in assisted living because there are elderly with dementia, Alzheimer's being the biggest contributor, that are residing in assisted living facilities. However, the biggest demand for a system to assist the elderly is called an emergency response system. It tells the 24-hour staff and security where the person is and who the person is, so they can get help there immediately."

With the competition heating up the marketplace, two factors are keeping the product developers moving quickly -- the speed of the technology and the design of the products. "An important aspect in any of these systems is speed, the monitoring system alerts the staff to get to that patient's door before the person gets out the door, and in the case of quick response the same thing -- speed -- is important," says Jonas. "Our product is a totally wireless system, which means it's a very installer friendly process, in particular with retrofitting facilities, as well as a very low cost in new facilities. It has many other features, such as it can be used on a campus environment."

As the seniors housing market expanded over the last several years, wanderer product manufacturers had to keep up the with supply and demand. "What has really driven some of the product such as ours is the miniaturization of components, that they're smaller and lighter, and that has allowed for smaller bracelets with more functional uses in them," says Brian Martin, president and CEO of Ottawa, Canada-based Instantel Inc. "For example, our products are microprocessor-controlled and that allows us to bring in new features that typically, in the form of software, allow us to upgrade systems in the already installed product base. And so you can keep your equipment and your investment current for a much longer period of time than what you could have before microprocessors. The electronic components have gotten smaller, so that has allowed for smaller and lighter tags, and the microprocessors have provided a level of functional response and upgrading that was not available before."

The security for the resident is a topic that relates directly to the facility staff and the type of monitoring system used within a particular seniors environment. "The best devices and systems are the ones that provide some comfort for the patient, in the sense that they can't be too big or too unwieldy, and they've got to be unobtrusive," says Martin. "For the staff itself, the people that actually have to use the system, it has to be reliable and can't false alarm or cry wolf. And so, because such a system can become one that nobody trusts, the system has to be reliable that when it generates an alarm is because a wanderer is attempting to leave the facility."

TECHNOLOGY IS KEY The technology needed to stay ahead of the competition is a major focus for product developers in the monitoring systems industry; therefore, many companies are having to look at the marketplace in terms of what is better, lighter or what is the next level of opportunity. "The aging population needs these types of products in their future and we will develop newfunctions and features as the market matures and grows," says Martin. "The low-e nd cost of technology, this is on an ever-declining spiral of cost, so there's two things you can do with that. One is to provide more sophistication and the other is to offer products at a more competitive cost." One advancement in product design coupled with technology was the placement of the bracelets on the resident within the facility. Wander-Guard, a Lincoln, Neb.-based manufacturer of monitoring systems, developed the wrist bracelet in 1985 and went to the next level in the industry. "At that time, the technology was using mats and mat antennas while putting the bracelet on the ankle, but this gave problems with people's ankles swelling and incontinence accidents. The particular type of technology that we offered was putting a monitor next to the door and a bracelet on the wrist of the patient, and soon this became the standard of the industry," says John Brasch, president of Wander-Guard. "We're not trying to oversell our technology, but the size of the device is not particularly the issue. People would like to see it go away, so you couldn't see it on residents, but if it's hidden the staff doesn't even know if it's on and they must visibly monitor the system on the patient."

Brasch notes that individual transmitter monitoring systems are used even at the independent seniors apartment level, where the resident has the most freedom of any seniors housing product type. "Our signaling devices are essentially boundary alarms, that was the term that was applied to them when they were first made available in Europe. If a person passed by a particular boundary, an alarm sounded even just out the door to a hallway, like could be in an independent apartment," says Brasch. "To the point, if you have a good boundary alarm system that people respond to, that's the first line of defense and if you have that, in our experience, it's effective nearly all the time."

One type of product that has come about with technological advancements are magnetic door locks. "The magnetic door lock does add cost, but it's very good technology and practical, and what it does is the patient is not going through the door and setting off the alarm. It's simply the resident walks up to the door and finds out it's locked for them and then they can move on to other activities. It's good technology.," says Brasch. "We have long been involved in selling wireless communications type of systems that are ideal for assisted living and have placed them in more than 150 facilities. At present, we are in the process of releasing a new architecture at the 900 megahertz level that's an outstanding product for a number of reasons. It offers portability for both residents and nurses, the residents can carry pendants and communicate , and the nurses can carry pagers."

MARKET VALUE MERITS SUCCESS Secure Care Products, a Boscawen, N.H.-based monitoring systems provider has been in the industry since 1979 and carries a unique aspect about manufacturing monitoring products: it is the only producer that originally owned nursing homes. "We had the knowledge of the industry and would go to our nursing homes and ask the nursing staff what features would be best and easy to use, then we tested the product in our own homes, which is pretty unique to the industry, for no one else has ownership of nursing homes," says John McCauley, vice president of sales and marketing at Secure Care Products, which was a nursing home owner for more than 55 years. "Our company was the first to design a transmitting device in 1979, and we have been doing it longer than anyone in the industry. We developed the first electromagnetic lock called Smartloc that will release a door within 15 seconds, whenever a force of not more than 15 pounds is applied to that door, such as when an Alzheimer's patient is wandering."

The assisted living marketplace has motivated the product developers to move forward with better identification systems for residents. Some of the features of these systems are: the ability to identify the wanderer by name and location, magnetic lock controls; elevator lockout; built-in audible alarms and perimeter alarm abilities. All these functions are state-of-the-art for wanderer monitoring systems. "So, the benefit there is if more than one resident walks out the door, you know exactly who you're looking for, and the staff can quickly go back to their room and see if they're gone," says McCauley. "The assisted living market has embraced our resident identification system because, typically, they're short on staff, like in a nursing home, and a lot of the new facilities use wireless systems. The networked systems tell the staff and security people what the resident's status is throughout the facility."

Perimeter Monitoring System -- A security system normally applied to exterior doors. A door system usually consists of an electromagnetic lock, an access control keypad and a delayed egress system.

Delayed Egress System -- A security device that opens a door after a delay period, (normally 15 seconds). The system usually consists of a panic bar-style door opener that if pushed continuously for three seconds, initiates a timer and sounds an alarm. The alarm alerts a staff member to the area where the resident has activated the alarm.

Electromagnetic Lock -- This consists of an electromagnet and fastener plate. The electromagnetic force holds the door closed at an industry standard rate of between 600 and 1200 lbs. of force. When the electrical current is temporarily disrupted to the electromagnet (when using a keypad to exit the door) the electromagnet "unlocks" until the current flow is restored.

Personal Monitoring Device -- A small transmitter, usually the size of a wristwatch, that is placed on a resident's wrist or ankle. When the resident approaches within three feet of a door that is on the monitoring program, the receiver in the door senses the proximity of the transmitter and engages the electromagnetic lock. When the resident leaves the area immediately around the door, the electromagnetic lock disengages.

Source: ManorCare Health Services.