Fortunately, this is an age where technology has advanced to the point where residents can be monitored through unobtrusive means. Wearable sensors, such as pendants, wristwatches and bracelets, allow caregivers to track residents effectively without making them feel like detainees.

“Fundamentally, we believe that if you enter a dementia care area and you notice the emergency call system — whether it’s buzzers and alarm announcements or flashing lights — the system is outdated,” says Sam Youngwirth, principal for CISCOR. “The system should blend into the environment and should not induce stress to the residents.”

With technology’s role in surveillance and protection of residents rapidly expanding over the past decade, systems and platforms have become more integrated, while sensors and software have become more intelligent and accessible, notes James Jansen, Direct Supply product manager of technology solutions.

“As a result, we are able to easily collect and interpret more complex data than ever before,” he says. “This data allows operators to make informed decisions, resulting in improved care outcomes and operational efficiencies. Connected technologies are the platforms that drive increased visibility into community operations, creating more opportunities to engage with residents.”

Mike McLeod, founder and president of Status Solutions, warns facilities about the “dreaded ‘I’ word — institutional” — when it comes to resident monitoring and surveillance.

“Senior living facilities have long had a reputation for being ‘baby hospitals’ and they have to change that perception,” he says. “They have to think of themselves as being a resort. They need to adhere to the basics. Whether standalone or continuum of care, they need to become something that people care about.”

A ‘FITBIT’ WORLD

Wearable technology has come a long way in a short amount of time, with “Fitbit” trackers counting steps, reporting vital signs and reporting biological data to wearers. The capabilities of these units have not only fostered acceptance from users, but unbridled enthusiasm, pointing to a new attitude toward technology’s role in health monitoring, sources say.

Laurence M. Yudkovitch, product manager for RF Technologies’ Senior Living Solutions, says that because wearable technology has gotten smaller, battery life has gotten longer and functionality more capable, devices can be worn 24/7. For instance, the RF Technologies’ Code Alert system includes a wrist-worn radio frequency identification wander tag that has a three year battery life, he says.

“This means we can monitor residents with memory loss and keep them safe in a facility for three years without the need to replace a battery,” Yudkovitch says.

Additionally, new wearable devices are able to capture more data at higher resolutions. Smart watches, for example, can capture heart rate in real time.

“It’s only time before these become mainstream in senior living,” he says.

McLeod calls the awakening to new technology “situational awareness” — society’s adoption of sophisticated technology and social media for communications, information and networking through apps for smartphones, iPads, Fitbits and Apple watches. Facilities can use these tools to create their own version of situational awareness for residents, he says.

“You need to build awareness by starting with competencies — alerting, monitoring and reporting — and build capabilities that give way to creation,” McLeod says. “Use situational awareness to prevent residents from experiencing negative events.”

PREDICTIVE TECHNOLOGY

Today’s monitoring technology is not only designed to be discreet, but to be proactive in protecting residents, Youngwirth says. By gauging resident routines, deviations from that norm signal that a resident may be having trouble and caregivers are alerted to intercede before a potential problem occurs.

The technology isn’t exactly new — CISCOR developed its product line eight years ago and at that time Youngwirth concedes the market wasn’t ready for it.

Over that time span, however, he says the concept has found a growing number of converts in senior living.

“It has become part of the nomenclature now,” he says. “The confidence factor is stronger than ever — not just in healthcare, but in our daily lives. It is part of our work and home environments and the comfort level has reached a point where it is here to stay.”

STRIKING A BALANCE

The most overt signs of resident surveillance are security cameras placed in areas where they draw attention. But how do facility operators compromise on the valuable visual images these cameras provide in order to keep residents from feeling like their privacy is being violated?

Jansen acknowledges that cameras are an important part of any security program, but adds the focus needs to be on “minimizing the security footprint” at the community.

A new report from the Alzheimer’s Association predicts that between 2015 and 2025, Medicaid costs for people living with Alzheimer’s disease and other dementias will increase in every state in the U.S. and the District of Columbia. In fact, by 2025, 35 states will see increases in Alzheimer’s Medicaid costs of at least 40% over 2015 levels, according to “The Impact of Alzheimer’s Disease on Medicaid Costs: A Growing Burden for States.”

Seniors with Alzheimer’s and other dementias rely on Medicaid, which is funded by state and federal governments, at a rate nearly three times greater than other seniors due to the long duration of the disease, the intense personal care needs and the high cost of long-term care services. According to the “Alzheimer’s Association Alzheimer’s Disease Facts and Figures” report, by the age of 80, 75% of people with Alzheimer’s and other dementias will be admitted to a nursing home, compared with just 4% of the general population.

The average per-person Medicaid spending for those with Alzheimer’s disease and other dementias is 19 times higher than average per-person spending across all other seniors, the Alzheimer’s Association “Facts and Figures” report notes.

The economic cost to society as a whole can be just as devastating, as total payments for healthcare, longterm care and hospice are projected to increase from an estimated $214 billion this year to $1.2 trillion by 2050.

Alzheimer’s is a triple threat, with soaring prevalence, lack of treatment and enormous costs that no one can afford. Barring the development of medical breakthroughs to prevent, stop or slow Alzheimer’s disease, state governments must anticipate the demands of long-term care on their Medicaid budgets.

Alzheimer’s symptoms include memory loss, confusion, impaired judgment and trouble understanding spatial relationships. Over time, affected individuals become totally dependent on others for all essentials of daily living. People with severe or late-stage Alzheimer’s eventually lose their ability to eat, bathe and manage their own bodily functions.

For this study, researchers at the National Cancer Institute looked at more than 221,000 individuals aged 50 to 71 years who were free of chronic disease when they entered the study. The researchers identified an association between TV watching and a higher risk of death from causes of fatalities such as cancer, heart disease, diabetes, influenza/ pneumonia, Parkinson’s disease and liver disease.

“We know that television viewing is the most prevalent leisure-time sedentary behavior, and our working hypothesis is that it is an indicator of overall physical inactivity,” said lead investigator Sarah K. Keadle, Ph.D., M.P.H., Cancer Prevention Fellow, Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute. Older adults watch the most TV of any demographic group in the United States, she added. Keadle cautioned that additional research is needed to replicate these findings and to understand the associations more completely.

The study found that, compared with those who watched less than one hour per day, individuals who reported watching three to four hours of television were 15% more likely to die from any cause. Those who watched seven or more hours were 47% more likely to die over the study period.

The detrimental effects of TV viewing extended to both active and inactive individuals.

“Although we found that exercise did not fully eliminate risks associated with prolonged television view- Researchers: Replace TV with exercising, certainly for those who want to reduce their sedentary television viewing, exercise should be the first choice to replace that previously inactive time,” Keadle said.

ANOTHER FALL RISK

Older people with an age-related loss of muscle mass and strength may be at greater risk of falling and bone fractures, according to new research led by the University of Southampton.

A team of researchers from the United States, United Kingdom and New Zealand studied people aged 70 to 82 years. They found that those with sarcopenia, a condition in which muscles lose form and function with age, had reported higher numbers of falls in the past year and a higher prevalence of fractures. The study was published in Calcified Tissue International.

MEDICATION REVIEW

A $3.4 million, five-year federal study will examine the off-label use of antipsychotic medications in residents with dementia living in assisted living communities. Researchers at the University of North Carolina at Chapel Hill will use funds from the National Institute on Aging to focus on the reasons for the use as well as potential alternatives.

“Many of these drugs have serious side effects, and there’s little evidence that they help people with dementia,” said the study’s principal investigator, Sheryl Zimmerman, Ph.D., a social work professor. Her collaborators in the study are family medicine faculty member Philip Sloane, M.D., M.P.H., Alzheimer’s specialist Daniel Kaufer, M.D., and biostatistics research professor John Preisser, Ph.D.

NEW TALKING BENEFIT

Face-to-face interactions help prevent depression in adults aged 50 or older, according to a new study published in the Journal of the American Geriatrics Society.

The probability of experiencing symptoms of depression steadily increased as the frequency of in-person contact decreased, researchers found. Those without in-person social contact with children, other family members or friends at least every few months had a significantly higher probability of clinically significant depressive symptoms two years later (11.5%) compared with those having in-person contact once or twice a month (8.1%) or once or twice a week (7.3%).

DANGEROUS DRUGS

People with diagnosed Alzheimer’s disease are more than three times more likely to be prescribed a benzodiazepine or related drug than those in whom the disease has not been diagnosed, according to a study by the University of Eastern Finland in press for the Journal of Alzheimer’s Disease.

The researchers also found that the drugs often are prescribed even before someone receives a diagnosis of Alzheimer’s and that use of the drugs becomes even more common after a diagnosis.

LISTEN TO COMPLAINTS

Don’t ignore residents who complain of memory problems. New research published in the Oct. 28 online issue of Neurology finds that older women who complain of memory problems may be at higher risk for experiencing diagnosed memory and thinking impairment years later.

“Our findings, though modest, provide further evidence that memory complaints in aging deserve close attention as a possible early warning sign of future thinking and memory problems, even several years in advance,” said study author Allison Kaup, Ph.D., who is an assistant professor of psychiatry at the University of California, San Francisco, and is with the San Francisco VA Medical Center.

The memory complaints could be an early symptom of a gradual disease process such as Alzheimer’s disease, she said.

Tech advances will help fuel better care outcomes while making delivery more efficient, he predicted. Three other trends he foresees:

• Baby boomers will be more demanding

• Healthcare delivery and payment system reform

• Greater demands for transparency

Kramer said this year’s meeting, the 25th, drew a record of more than 2,400 capital providers and seekers.

He noted that seniors housing and care options will continue to evolve and adapt to customers’ changing needs and preferences.

“What you are seeing today will be boring conformity compared to what you’ll see in the future,” he predicted.

For practically every challenge the field has faced, technology has answered the call, even as the so-called “continuum of care” gets longer, broader and more ambiguous and diverse with each passing day.

It’s also keeping more and more of the elderly away from institutionalized settings like nursing homes. Thanks to modern medicine, people are living longer while staving off disease and infirmity. Today, technology is helping residents live more productively and joyfully, while giving those who care for them tools to not only provide better care, but work more efficiently.

As the lines become more blurred between care settings and seniors have more choices — from aging in place to retirement communities to “hands-on” settings like assisted living — technology’s influence only gets more disruptive. And innovation sometimes comes from the most unlikely places.

Consider the 12-by-24-foot MEDCottage, a parallel to the current “tiny house” movement in America, which some seniors are opting for as a way to stay close to adult children while remaining “independent.” Conceived by a Virginia minister whose parishioners felt loss after placing their parents in nursing homes, the sardonically dubbed “granny pods” come standard with such low-tech ergonomic features as hand rails to higher-tech add-ons like defibrillators, interactive video, bed- and bathroom seat lifts, physician- connected sensors that monitor vital signs and glucose levels, toilet seats that record and upload weight and body temperature, medication reminder systems — even floor-level cameras that record and send alerts when falls occur.

A NEW ERA

The tech tsunami the senior living industry is currently swirling in has reached landfall, in large part, from the confluence of two major trends: the “Internet of Things” and the push toward resident-centered care, a once nascent movement boosted by healthcare reform.

We find ourselves drowning in a dizzying array of interconnected mobile devices and sensors, flooding the airwaves and the ether with data. In their nexus: seniors. “It’s all about persistent connection,” says Mike MacLeod, founder and lead strategist of Status Solutions, a high-tech situational awareness solutions provider. “That makes all the difference. Whether you’re 5 or 75, the ‘Internet of Things’ can help everyone. While the issues a 5-year-old is concerned with are quite different, the technology doesn’t care.”

Even five years ago, you’d be hard-pressed to see a 75-year-old swiping her thumb across a smartphone screen, much less a tablet PC. But no more. Many of the 78 million “baby boomers” today are doing just that, according to Pew Research. And they’re entering senior living communities with those devices wanting to stay connected with the world they left behind.

And tech has responded in spades.

Take wearables — the newest fad in personal sensors that collect, analyze and upload biometric data and send alerts to designated individuals when bodily functions go awry. IHS Technology predicts that sensors in wearable electronic devices will riseby a factor of seven through 2019. HL7 Standards, a healthcare software company website, predicts that 5.5 billion people around the world will be attached to some kind of personal monitoring device by then.

Tablet usage among seniors rose 125% in 2014 alone, according to Mobile Smith, a Raleigh, NC-based mobile app platform developer. And the number of “apps” driving them is growing exponentially by the minute.

Major shifts in healthcare regulations are, in part, fueling it. As of this writing, more than 40,000 medical- and health-related apps for seniors and others were available for Apple’s iPhone alone, according to Bankrate.com. One app, aptly title “GetMyRx,” will allow users to scan a prescription into their smartphone and have the medication delivered to their front door in hours.

Even organizations like LeadingAge are getting into the act, recently running a two-day “Hack- Fest” programming event recognizing the winning app that helps residents set activity goals, says Josh Malbogat, senior living director at TheWorxHub by Dude Solutions.

IDEAL SETTINGS

Observers say senior living settings are ideal incubators for tech innovations to thrive, in large part because most residents are at a relatively high functional state.

Many are also tech savvy, and very receptive to things like social media and mobile health technology.

The focus today is on making that technology accessible and easy to use.

For example, Philips Healthcare, a provider of cloud- and device-based digital health management solutions, reportedly announced it was working with MIT AgeLab and Georgetown University to better learn how older adults and caregivers interact with technology.

“The kinds of new tech considerations in elder living aren’t leaving behind old guys who never learned how to type,” MacLeod says with a chuckle. “They eschewed email. So we’ve made it easy with touch screens and other tools so they can easily stay in touch with their grandchildren. Those things matter.”

That is precisely the impetus behind Telikin, a 6-year-old company that developed a line of touch screen PCs bundled with proprietary software that allows seniors to email, access the Internet, share photos and videos and place video calls through Skype and other social media sites.

Assisted living is a prime target for Telikin’s devices, says Fred Allegrezza, founder and CEO. “We did a survey of potential customers and found that about half had experience on Windows computers in the past but got frustrated with all the software updates,” said Allegrezza, who built his systems on the Linux platform known to be immune to viruses and other glitches.

“Our team is really focused on understanding seniors, not treating them like patients or talking down to them. It’s heartening for me to see a daughter in Ohio and her mother at an assisted living facility in Florida light up when they’re connected by Skype,” the 35-year computer engineer beams.

One of the biggest challenges senior living operators face is how to manage all that data flooding through the pipes.

For example, growing participation of long-term and post-acute care providers in accountable care organizations and other bundled payment programs is bringing its own unique data sharing challenges, says Doc DeVore, director of clinical informatics and industry relations, Answers on Demand, a residentcentric integrated clinical and financial software provider.

“In order to make well-informed decisions on resident health, senior care organizations need to be able to easily access health information with secure exchanges,” he adds. Another major concern: resident privacy.

Philips Healthcare’s HealthSuite application collects, compiles and analyzes clinical and other data from multiple devices and sources across various senior living settings. The Dutch firm, meanwhile, announced its collaboration with Amazon Web Services to enable an “ecosystem” for new types of connected and personalized digital health solutions. Yes, Amazon.

McKnight’s Senior Living interviewed many tech companies recently to gauge their thoughts on the current state of innovation. Here’s a quick summary of what we learned:

Mike MacLeod, Status Solutions
“The former situation in assisted living was not great. They had pretty good tools but not great ones. Now they’re getting great tools and are making great use of those tools like having the ability to see if someone is getting lonely, what meds they’re taking, or how often they’re interacting with their families. Technology gives greater visibility and more real-time awareness to all those things.”

Josh Malbogat, Dude Solutions
“Assisted living tech is being used to keep residents independent for longer periods, compared to skilled nursing, where technological innovation tends to focus more on managing illness and service delivery. He added that innovation is brisk in the area of remote monitoring tools for ADL, resident tracking and medication management, as well as increased interest in family portals showing resident health status, and motion sensors that take residents through a series of goal-oriented exercises.

Marina Aslanyan, CEO, SmartLinx Solutions, a software-based workforce management and business analytics company
From her perspective, software solutions that improve staff productivity are helping to stem turnover rates that are reaching critical levels. “One area we see a lot of momentum in use of mobile devices, and particularly employee self-service. Continuity of staff is important because routine is critical for many residents who prefer familiar faces to high turnover. If a provider is constantly churning and burning employees, it obviously creates a more tumultuous environment in senior living.”

Martha Abercrombie, vice president of strategy, Vikus Corp., a dedicated online staff hiring platform for senior care providers
Much like Aslanyan, Abercrombie believes technological innovations that help senior living providers “find and keep the right staff is becoming more and more of a focus for senior living.”

Marcia Conrad-Miller, senior director, business transformation, Philips Healthcare
Conrad-Miller believes that while investment in technology is brisk in assisted living, it’s too focused on the basics right now. “For example, investment in high-speed Internet and resident access is high, yet innovations that can ride on top of that technology, like brain fitness apps, are lagging. One “exciting” technology, meanwhile, is a device designed to automatically detect falls (Disclosure: Philips makes such a device.)

Rachel Owens, vice president of product management, PointRF Solutions LLC, A provider of real-time location services and healthcare data analytics
Owens, a big proponent of “gamechanging” wearable tech, astutely points out that so many technological innovations now “consumerized” and cropping up in senior living were seeded in acute care environments. A popular example is health monitoring devices. Owens said PointRF is currently in the process of bringing “FDA approved” health sensors to the sector “in a way that will reduce time spent with and errors related to data entry to allow staff to focus on their residents while automating the capturing of necessary and valuable health status information.”

Dave Wessinger, co-founder and chief technology officer, PointClickCare, a cloud-based software provider of EHR and solutions related to billing and revenue capture, and referral, dietary and medication management
It’s no surprise Wessinger believes analytics is one of the brightest innovations to reach senior living, “thanks to the advent of big data.” For example, wellness coordinators can now use iPads or smart phones to easily provide updates on a resident, allowing the data to be recorded and stored securely in real-time “so the right people have access to the right information at the right time, and can act on it without delay.”

FUELING POSITIVE IMAGES

Everyone agrees on one thing: Senior living tech can and does influence consumer decisions about placement.

To better understand how senior living operators are meeting resident and family expectations, PointClick- Care and LeadingAge’s Center for Aging Services Technologies led a joint market assessment survey last June that found nearly 70% of them believed investing in technology paves the way to achieving a competitive advantage in today’s market, making technology a top priority, Wessinger tells McKnight’s Senior Living.

Malbogat says he thinks such trends will be self-evident in the next generation of seniors to move into senior living and other settings. “The baby boomers that communities are prepping for and that are currently helping their own parents move into these communities expect technology to make their lives easier and enable more choice on how they want to live within those communities,” he says.

For self-proclaimed “strategists” like MacLeod, those not-so-subtle differences are staring him in the face. “Assisted living communities are essentially extended stay hospitality settings and the technological amenities you have absolutely matter,” he says.

“If I’m coming in to check out your facility to see if it passes the sniff test in terms of the technological amenities I want for my parents, then, yes, it’s a huge and relevant differentiator,” he adds.

“My folks are in their late 80s,” MacLeod says. “They are as tough as a two dollar steak. They’re the silent generation so named because they don’t complain. They were the last ones to get air conditioning and cable TV. However, I complain a lot. We’re spoiled compared to our elder parents. Me as an adult child making decisions for my folks is very different than my folks making decisions for themselves.”

FALLING SHORT

With all of its promise and buzz, senior living tech still falls a bit short. For tech companies, that only spells opportunity.

Here’s a look at some of them:

• Data analytics. Conrad-Miller believes we have a ways to go in learning how to use all that data around a person’s health, patterns and activities for predictive analytics “to recommend when particular services can be provided to ensure health and well being.”

• Big picture stuff. “The long-term post-acute care industry is in transition, faced with new challenges and new opportunities unlike ever before,” says Wessinger. “Providers across all care settings are feeling the impact of this shift and looking really closely at the role technology plays in helping drive their business forward. As the demographic shift in the senior population unfolds, technology becomes more necessary to push for the efficiencies that senior living providers require. Strategic technological solutions are essential, and even more, finding the right technology partners will be key in sustaining business.”

• Resident and family connectivity. Yes, seniors have smartphones and tablets, but just how connected are they really to caregivers? “The key missing piece now is reciprocal communication between residents, communities and family members,” says Malbogat. “This means giving visibility of the overall health and engagement of the resident and providing them tools to engage as they choose with the community — everything from being able to go online and put in a work order to signing up for activities to tracking what medicine the resident is taking.”

• Stopping the bleeding in staffing. Turnover will continue haunting all kinds of elder care settings. No one disagrees with that. Abercrombie cites a recent University of Tennessee at Chattanooga study of over 300 providers, among whom half of the 94% posting jobs online to find staff believed their recruitment process was going to help them meet their turnover reduction goals. “In other words, technology is being used to reach applicants, but not to select the right person,” she adds. “There are many solutions offering a better mousetrap to automate the hiring process, but they are not creating quality outcomes for staff or for residents. Instead, they create a revolving door where staff are hired, leave, and are replaced, usually within their first 90 days.”

• Telehealth. They’ve been talking about it literally for decades. The technology is there. Someone just needs to get on board, some say. Telikin’s Allegrezza tells McKnight’s Senior Living he is conducting telehealth trials in three locations to determine the feasibility of incorporating it into his bundled hardware and software devices in senior living settings. “This would be beneficial for people even in assisted living who have challenges with transportation or who aren’t feeling well and need low-level medical care,” he says. “We’re starting to see a lot of traction in this area now. It just takes someone to start doing it at a very basic level.”

MOVING ‘THE HERD’

A recent article posted by Brookdale Senior living stated it succinctly: “Technology shows no signs of slowing.”

Indeed. In certain instances, it’s too much, too soon. Take robotics. While they’ve shown remarkable efficiencies in manufacturing, assembly and production, we still have a way to go before caregivers feel threatened. In its piece on the subject, Brookdale noted a Human Factors and Ergonomics Society study that found seniors little receptive to robots for anything other than housekeeping help and medication reminders.

For inventors like MacLeod, it all comes down to identifying a need and finding a plausible and acceptable way to fill it.

“The whole thing about technology innovation is, it’s never over,” he adds. “It just started the last time you checked. What you think of today won’t be as good as what we think of tomorrow. If someone in assisted living or any other space wants to go from the current situation of standing in the sun to the desired position of being in the shade, the trees won’t move toward them. They have to move toward the trees.”

The key for MacLeod and other tech companies is getting providers to move forward.

“The herd needs to get some prodding and poking,” he says, tongue-in-cheek. “The thought leaders lead. The fast followers follow. And the herd moves. A lot of people who own and operate communities are procrastinating right now. It’s time for them to get in the game.”

Practices designed to ensure safety and efficiency can undermine a resident’s sense of independence, leading to sometimes violent shows of resistance or less-then-stellar hygiene compliance.

But simplifying the process with the right equipment — and employees and procedures that promote flexibility — can restore the comfort often associated with bathing earlier in life.

“Anytime someone has to have assistance with something they’ve spent a lifetime doing themselves, we can run into difficulties,” says Ruth Drew, director of family and information services for the Alzheimer’s Association. “That includes bathing. Think about how you would feel if someone you’d never seen before were asking you to get undressed for a bath, and you don’t even think you need a bath.”

For years, interior designers have worked on making patient rooms and community spaces more “homelike.” Bathrooms have often been overlooked in this conversion.

Today, options abound and skilled nursing and assisted living communities are taking note, says Megan Multanen, national sales manager for Best Bath Systems.

“We see a real interest growing there,” says Multanen, who recently helped set up 12 baths incorporating universal design in spa-like suites at a private facility.

The best baths, showers and spa products offer more than sleek looks. Quieter motors, better seating and options that let residents choose between bathing or showering can be the difference between bathing bliss or bathing battles.

MTI Baths, maker of customizable whirlpool tubs, puts stock in the power of water to purify and potentially heal. The company points to research by the National Arthritis Foundation that says water’s gravity-reducing effect reduces pressure on joints, muscles and bones. Warm water therapy — even just a restorative soak — can be a plus for patients with fibromyalgia, arthritis or low back pain. MTI reps say hydrotherapy is also indicated for patients with diabetes, insomnia, stress and poor circulation.

“The combination of warm water and water movement below the surface enhances circulation to extremities through massage and by dilating blood vessels,” says David Anderson, national sales manager for Apollo Bath. He adds that baths also trigger the release of endorphins, the body’s natural pain relievers.

But what about residents with more severe needs, such as multiple sclerosis, severe obesity or dementia? Showering also can deliver a relaxing experience, especially if the process provides a measure of privacy and allows a resident to control some variables.

One factor that can’t be overlooked, says Fran Spidare, Invacare’s product development manager for safe patient handling, is the speed at which bathing or showering is completed. Having enough tubs and showers per facility is a critical element in a successful hygiene program.

“You want it not to become like a car wash,” says Spidare. “It’s a human being in there, and you have to allow time for that.”

For maximum safety, adds Lee Penner, president of Penner Patient Care, there should be consideration given to “a transfer system that is an integral part of the bathing unit.”

This could include things like a swivel seat; whatever it comprises, the transferring materials should be able to go into the water with the resident, he adds.

CLEAN CHOICES

Spidare says investing in new bath equipment is a twofold scenario: Administrators want something that is comfortable for the resident yet helps make the caregiver’s job easier. Many modern products are designed to deliver on both counts.

Invacare’s Therapure line, for example, capitalizes on removable jets to give facilities an easy-to-clean bath. Such tubs can work well in large bathing rooms or any area where multiple residents might be sharing the same equipment.

More importantly, Spidare says, the jets operate below the surface without creating a torrent of bubbles on the surface. That’s key for dementia patients who might be upset by the noise and motion of high-velocity jets. Drew also notes that bubbles can add to depth-perception issues experienced by many Alzheimer’s patients.

Equipment that’s easy to disinfect is more prevalent than ever. Apollo offers a UV water purification system on its whirlpool baths, which kills bacteria while the patient bathes to reduce the chances of transmission through open areas such as diabetic foot lesions.

MasterCare’s BathAire technology blows only heated air out of self-sealing aerators with check valves, ensuring that used water doesn’t stagnate in supply lines. The company has also invested in equipment that provides support for incontinent patients. The company’s FlushCare feature allows residents to void in a tub or shower cabinet fitted with a special compartment and sealed lid.

“It is a sanitary and more dignified way to eliminate accidents for staff and embarrassing moments for residents,” says Marketing Manager Rachelle Congdon.

Lifts also can ease the process, with some designed specifically to move patients from the toilet to a tub or shower stall bench.

FLEXIBLE OPTIONS

Other companies are looking at options that require less movement but allow more access.

Best Bath’s roll-in shower can move from one private room to another. At 29 inches by 29 inches, it fits in most standard-size showers. And unlike a traditional seated shower that restricts access to a patient’s underside, the Oasis model features four pads that drop down independently to make sure private areas get cleaned.

The Oasis promotes safety for both the patient and caregiver because there’s no lifting or awkward repositioning required, says Multanen. Either a caregiver or a patient uses a remote control to deliver a complete head-to-shower experience, or aim sprayer jets or a handheld head to avoid specific areas (such as a broken bone or recently styled hair).

As Anderson notes, it’s critical that bathing protocols adhere to doctor’s orders to avoid surgical sites or casts, even if one staff member is typically enough to help a given resident shower, temporary needs may require a second employee to help secure waterproof coverings or implement other precautions. Active wounds with drains always should be kept dry, though Anderson says bathing can help prevent pressure wounds by lessening the weight pushing down on the gluteal and coccyx areas.

Recumbent baths also cater to patients with physical and cognitive limitations. Apollo’s Pacific Shower Bathing Trolley works well with dementia residents who may feel more secure in a recumbent position, Anderson says. An optional wedge pillow helps elevate the upper body so residents feel less threatened by the water level when used as a tub, and the sides rise to block the view and reduce fears of rolling out of the tub.

PERSONAL PREFERENCES

Whether they’re showering or bathing, patients often appreciate the same basic courtesies. Drew says that begins with being given choices. Bath or shower? Morning or evening? She tells the story of an Alzheimer’s patient who always bathed the night before church when growing up. His daughter often gets him to the tub willingly by claiming it’s Saturday.

“It’s so worth it to know the person (being cared for) and cater to their needs,” explains Drew. To develop that kind of knowledge about a resident, facilities could assign the same staff to a resident routinely. Even offering a scented soap reminiscent of home can help, says Spidare.

CHALLENGING ACTORS

Many Alzheimer’s patients, in particular, act out in response to bathing. Drew says they could be acting out of confusion, feel unsafe or simply be unable to communicate that they’re cold. Simple strategies such as allowing them to shower with a towel over their lap, using heat lamps, running a warm showerhead over the back while a tub drains or having warm towels on hand can all make the process feel better.

Much like dementia patients, elderly vets may act out at bath time if they associate water or the intimate act of bathing with a suppressed trauma. They may hit, pinch, curse or throw objects, says Yvette M. Rose, MSN, RN, who presented evidence-based guidelines for helping such residents during the 2015 Aging in America Conference.

Rose says the mental health of elderly males with delayed-onset post-traumatic stress disorder is a growing concern in long-term care facilities. Her guidelines are adapted from principles used with Alzheimer’s and other dementia patients, and intended to provide a bathing experience that reduces agitation, aggression and discomfort.

Tapping into positive associations can help some patients as well.

The Adjust-a-Sink is built on that concept. The product is typically used in long-term care salons, making hair washing more comfortable for those who can no longer lean back or those who use wheelchairs.

“It allows a more pleasant, dignified experience for the resident,” says President Arden Olson. “There’s also no need for a transfer, so there’s less potential for a fall with wet floors and less risk with lifting.” “When patients feel good about their appearance, they feel better overall,” Olson says.

“There is a lot of housing being constructed, but the working class is finding it hard to find suitable housing within their means,” he says. “This is a great blue collar area full of hard-working people. This had the chance to be built, so we did a market study and found that the people of Belleville wanted to stay there. It is a myth that people in the small towns want to be in the big city. For the most part, people want their town to progress a little.”

Consisting of five one- and two-story buildings totaling more than 31,000 square feet, the Cottages at Cathedral Square are situated near the historic and picturesque Cathedral of St. Peter, a city landmark for nearly 150 years. The $6 million project came about through a partnership between MDHC and Touchette Regional Hospital, which previously developed senior living communities in Centerville and East St. Louis, IL.

The design theme is based on the region’s history and especially “the glory days of the 1930s,” Gonzalez says. “We wanted the project to have the old German row house influence from the turn of the 20th century. Although they are called ‘cottages,’ these are real homes that have a warm feeling to them.”

All 32 units at Cottages at Cathedral Square are for low-income residents age 62 or older and include a range, refrigerator, microwave and dishwasher. The community’s amenities include a barbershop, a large community room, fitness center, gardening areas, patios, and barbeque grills. Touchette also has a medical clinic located near the development.

It is also the first facility in Belleville to receive the ICC 700 National Green Building Standard’s bronze certification for green practices incorporated into its design and construction. The green certification was awarded for its inclusion of energy- and water-efficient appliances, low-flow faucets, toilets and showerheads, and low VOC cabinets and carpets.

The certification also recognized Cottages at Cathedral Square as an infill project within walking distance of regular-use resources, including hospitals, the YMCA, schools and parks; and for its use of native landscaping and limited grass; a community garden and its household density per acre.

“This project will undoubtedly have a positive impact in downtown Belleville and will hopefully stimulate similar, additional new development in the future,” says Mark Hinrichs, president of IMPACT Strategies.

3 LESSONS LEARNED

1. In this type of community there is a greater demand for one-bedroom units than two.

2. When there’s a partnership between a private entity and government agency, society benefits.

3. Building for low-income residents can bring huge rewards and offer hope to seniors who may have no other housing options.

But as one highly regarded brand recently learned the hard way, the aura of prestige doesn’t always deliver at crunch time. That venerable company is none other than American Express. Yes, the American Express with more affluent users than MasterCard or Visa. The firm with a cachet that has allowed it to charge merchants a higher swipe fee. The company with customers who run up the highest charges. The company that gave us the black titanium charge card. Yes, that American Express.

But after a 16-year “marriage,” American Express and Costco Wholesale Corp. are ending what many once saw as a match made in heaven. As a result, Costco will no longer accept just AmEx cards for credit purchases.

According to several reports, AmEx officials became incensed during recent negotiations when Costco managers referred to the august firm as a lowly “vendor” instead of a “trusted partner.” But what really hurt was when Costco CEO Craig Jelinek allegedly said AmEx was no different than a ketchup supplier — and if he could get a better deal on ketchup someplace else, he would.

Where did the love go?

Following the announced breakup, two interesting things happened. One is that AmEx stock plummeted. Then it was revealed that about 10% of all AmEx cards — about 11.2 million — were Costco-branded. Apparently, many people seeking the cachet of an AmEx card were not above buying paper towels and mayonnaise by the trunkload.

So what lessons can senior living operators take here? I see two.

First, the business partner who loves you today may not want you around tomorrow. Corporate marriages can be a lot like actual ones, except they tend to be far more fickle. Begin any potential partnership with an exit strategy in mind. Second, never forget that all appearances to the contrary aside, senior living remains a commodity business.

Yes, you might be currently sitting on a nicer piece of real estate and offer higher-end amenities than your cohorts in the Yellow Pages. But what’s to stop any competitor from eventually overtaking you? In a word, nothing.

If you are counting on your secret sauce to carry the day, here’s a stark reminder: To many of your residents and their check-writing children, you really are the equivalent of another ketchup vendor. When they can get a better deal elsewhere, they will.

Researchers developed JustoCat^®, an interactive robotic cat that breathes, purrs and meows, in an effort to meet the need for alternative forms of care for the growing number of individuals with dementia, said Christine Gustafsson, Ph.D., the study’s lead author. 

Evidence has shown several calming benefits to spending time with a pet, but for those with dementia, obstacles include a risk of infection, allergies and injury. In addition, pets come with additional responsibilities for caregivers. After learning about the promising outcomes of the robotic seal, PARO, on improving the mood of patients with Alzheimer’s disease in Japan, Gustafsson and her team designed a robotic companion to appeal to individuals in Sweden, where cats are a common domestic pet and are therefore more likely to work as a reminiscence therapy tool.