By SHANNON LUNDBERG. 11.07
Maria has been diagnosed with dementia, but one wouldn’t know it from visiting with her. She’s quite comfortable in her environment, enjoys friendships with other residents and staff members, and helps daily around her household. Maria is doing well because the house where she lives, although a residential care community looks, feels, and smells like home with its small scale and warm staff interactions. Mary doesn’t know that she lives in a high-tech smart house, or that the staff members are able to effectively communicate, collaborate and coordinate with the help of a fully integrated information system.
Steven Esser is the operations manager of the household where Maria lives at Elite Care’s Oatfield Estates in Milwaukie, Ore. He starts each day taking 10 minutes to glance at the Team Huddle Web page. Preparing for the day he quickly reviews each resident’s progress notes and sensor information, such as daily movement, time in bed, or number of alerts. He knows immediately whether or not Maria had a restful night’s sleep, and he plans his day accordingly.
In many other long-term care (LTC) facilities, the larger scale would be disorienting, and Maria would likely try to leave. Elite Care’s use of a monitoring and electronic documentation system supports the operations in a like home environment.
Elite Care aims to enhance community based care through an integrated monitoring and electronic documentation system developed by Elite Care Technologies (ECT), a related software development company, where I serve as product manager, through which we have also installed similar systems in three other facilities elsewhere in the United States.
Elite Care is a family enterprise. Founders Bill Reed and my mother Lydia Lundberg, a husband and wife team, created the technology company and developed Oatfield Estates to create a community where they would want to live.. To meet their criterion, Bill and mom designed Oatfield to be home-like, elder directed and support aging in place. The six-acre campus holds six craftsman style houses, each with 12 to 15 residents. Steve and other operations managers work with residents of each home to make decisions and run the household.
The ECT system is meant to emulate the intimate knowledge that family caregivers would have of the loved they cared for at home. Traditionally, for example, an adult daughter understands her parents’ normal activities and keeps a close eye on the daily routine and living patterns as she monitors their wellbeing. In today’s setting, family caregivers are often challenged by distance and other factors and use paid employees to supplement care.
“Aging in place” is more than a slogan to us. Residents of mixed ability levels live in each house so, for example, couples can continue living together in spite of varying needs, and individuals can stay in their new home, even as their needs change over time.
The ECT system is one tool we use to make this operating model economically and operationally feasible. The system consists of simple components. Residents and staff members carry a badge that emits radio-frequency and infrared signals picked up by sensors stationed around the campus. Load cells installed under each bed continuously monitor every resident’s weight, a critical health factor. Analysis of this data provides trends in weight, time spent in bed, rising and sleeping time, and restlessness while in bed. All sensors are integrated with an alert system so that staff can be summoned when events take place that might cause concern.
It was exciting to be part of this new, high-tech approach to LTC. In our first phase of development at Oatfield, we focused on collecting information and sending alerts when appropriate to staff members, such as when a resident wandered too far. Management used information collected by the ECT system to gain insight into events after they took place. Sensor data has often proved helpful when the staff has had to address the concerns of family members and regulators. The use of the information system taught staff the value of operational transparency. Sensor information itself has no agenda, it simply reports what is seen, and is a tool to provide context to a situation.
With Oatfield Estates serving as a living laboratory, we discovered which information was useful to management, staff and family members. Today we focus on the user interface and the interpretation of information. In order to make alert signals helpful, we needed a user-friendly interface so that nurses and managers could easily adjust and set the parameters of the alerts to meet a resident’s changing needs. Furthermore, we adjusted the delivery and representation of information to be meaningful to staff who would view them. For example, we created a graphic presentation of in-depth reports to show trends over time, such as on a resident’s weight or behavior.
In practice we have discovered that the ECT information system empowers care recipients, connects and engages family members and supports a person-centered model of care. A wireless “help” button that residents and staff wear, allows community members to call for help from any house on campus, thereby providing freedom of mobility. Easy access to data showing where any resident is located is available to staff via a secure Web portal and allows staff members to support disoriented residents in an open environment without seeming to hover over them.
In addition, ongoing monitoring allows resident’s daily life routine to become its own form of communication. For instance, changes in sleep patterns, or daily movement can alert staff what a resident may not be able to express with words.
The ECT system also uses its collected information to engage and connect family members to their loved ones. Access to trend information, a resident’s location and reports seems to offset the geographic separation that challenges today’s extended families. With a resident’s permission, family members have access to system information through a secure Web interface. Families can review the number of assistance calls, when their family member called for help, as well as see who answered the call and how long the response took. They can also view trend information in movement, restlessness, sleep, weight, social activity participation and percentage of time spent with others or alone.
Families report that access to the Family Portal provides them peace of mind and a sense of connection to their loved one. One Oatfield resident proudly stated that her daughter checks in on her daily from Florida. She finds this comforting, because her daughter would know if anything were not in alignment. Family members also use this information to prepare for visits and to participate in reviewing service plans with staff. Ultimately, providing access to this information engages a family member in a resident’s support team and creates a collaborative spirit between a care provider, care recipient and family.
The backbone of the ECT user interface is the Team Huddle, an operational dashboard that places all relevant information on a single electronic page. Staff members view this webpage at the beginning of each shift. On screen they can observe quality measures for each resident, such as number of alerts that were signaled, time in bed, weight and movement. From this interface staff can also read and compose progress notes, document incident reports and view the resident’s face sheet and service plan.
By monitoring vital information on a daily basis, the staff is continually updated. The Team Huddle indicates at a glance whether or not all is well for an individual. Coupling the information system with human observation adds to the depth of understanding. Reviewing progress notes becomes simple for managers, who can easily examine the Team Huddle to compare observations to sensor information.
We have found applied technology to be an invaluable tool in building an elder-directed community with actively involved participants. Access to information engages our residents’ family members, allows staff to spend more time with the elders, and supports residents in living the life they would want. Perhaps the most amazing part of ECT system is that when applied, one hardly notices it. Instead, the vibrant residents, attentive and caring staff, and participating family members keep the high-tech aspect where it belongs, in the background.
Shannon Lundberg is the product manager for Elite Care Technologies. For more information, contact her at shannon@elitecaretech.com. This article is based on her presentation at the On Lok FutureVision conference held in San Francisco in June.This article originally appeared on Aging Today.