With labor accounting for more than half of the laundry budget and laundry equipment consuming significant energy, water and other precious resources, finding ways to do more with less — and with better outcomes — makes good business sense.

Swapping outdated washer-extractors and dryers for more sophisticated, efficient models is a high-impact strategy worth considering. Although these capital equipment purchases can initially put a dent in the budget, they also can quickly pay for themselves in increased throughput and a reduction in resource consumption, Practice Green Health reports. Washers built before 2003 are a prime example. According to the Environmental Protection Agency, which created the ENERGY STAR international standard for energy-efficient consumer products, older washers are significantly less efficient than newer models.

“ENERGY STAR-certified washers use roughly one-third less energy and 40 percent less water than regular models,” the EPA notes.   

Of course, dryers, extractors, chemicals and staff practices also factor heavily into overall efficiencies and a facility’s environmental impact. These days, the market is brimming with innovative solutions that make it easier than ever for staff to improve laundry operations, without taking a toll on the environment or bottom line. 

Cycle right

Incorrect cycle selection is one of the biggest and most costly mistakes laundry operators make, experts say. 

“Lightly soiled linens, for example, typically don’t require the same wash program or treatment as heavily soiled linens. If staff are running the same cycles for all loads, that means wasted water, energy and chemicals,” explains Bill Brooks, UniMac North American sales manager. 

Today’s advanced washer-extractors feature dozens of wash cycles — as many as 30 water levels and temperature choices — he pointed out. But if programmable features aren’t being used effectively, they’re a wasted benefit. Brooks recommends long-term care facilities work with their equipment distributors and chemical representatives to pre-program the wash cycles and chemical usage based on the most popular loads and health regulations.

“Then, selecting the correct option is as easy as staff touching a button and pressing start,” he says.

Brooks recommends facilities without an advanced washer-extractor with flexible programmable options familiarize themselves with typical loads, and which cycles and chemicals those loads typically require to ensure that resources are used wisely.

Water is a dwindling and costly resource, yet experts say many facilities unknowingly use too much. Laundry operators nationwide should adjust their washers’ water levels and, if possible, program their machines to ensure that fill levels aren’t set too high, and that chemicals aren’t wasted when too much water is in the cylinder. 

Proper water level programming can save thousands of gallons of water over the course of one month, says Dan Goldman, OPL national sales manager for Laundrylux. 

At the same time, operators should avoid under-filling their machines, an all-too-common problem that’s not only costly and wasteful, but can impact the washer’s performance and lead to premature breakdown of both linen and the equipment itself. 

“Under-loading occurs seventy percent of the time, especially when the operator doesn’t weigh the loads prior to processing,” Goldman says. Electrolux’s latest washers weigh laundry and automatically adjust water levels according to poundage.

Facilities using front-loading washer-extractors without the latest high-tech features can follow this advice from Gary Gauthier, regional sales manager for Milnor Laundry Systems: Fill the machine until there’s a football-shaped and football-sized space at the top of the basket. 

“Some people worry that putting too much into a washer is bad for the machine or that the goods won’t get clean,” he says. “In fact, under-loading is much worse on front-loaders because this can cause out-of-balance extracts that will prematurely damage bearings and the machine’s frame.”

Get the formula

Cleaning chemistries should also be carefully evaluated for their efficacy and environmental impact, sources agree. Sunrise Senior Living has seen a big ecological and economical impact by using a solid chemical system. 

“By using solids, we’re able to mix with water on site and help reduce the gasoline that would have been used to deliver gallons of water-based chemical product,” notes Andy Coelho, SVP of facilities at Sunrise.

A number of cold-water chemistries that can clean textiles effectively with less heated water are also on the market. Energy use is often most impacted by water temperature, stresses Gauthier, so it’s important to consult with the laundry chemical supplier to ensure that appropriate water temperatures are being used.

Another piece of expert advice: Don’t overuse high efficiency detergents. As Dan Hayes, president of Creative Laundry Systems Inc., explains, HE detergents, which capture and hold dirt particles away from fabric, so they can be rinsed away cleanly, are designed for use in low-water environments. 

“Using too much detergent is like using too much shampoo and not rinsing it all out,” he says, adding that too much detergent leaves fabric stiff and scratchy. To release detergent residue, he suggests washing with a half cup of white vinegar instead of detergent. “If you do this with towels, you’ll feel how soft they are without soap when the residual soap is gone.” 

Excess detergent also can interfere with sensors in the machine that monitor the balance of the load, Hayes cautions, and can clog drains and plumbing. What’s more, excess bubbles build up in the cabinet and drum, and can reach the main bearings that ease the drum’s spin. 

“Once the bearings fail due to soap build-up, you have to buy a new machine,” he warns.

Heating up the savings

Another simple way to shave waste is to nix over-drying. Excessive dry cycles drain time and energy, and also break down textiles, resulting in higher replacement costs. Bypassing set drying times on the tumbler is a common mistake seen in almost every laundry room, according to Goldman. n

Yet in order for the facility to enhance the idyllic, picturesque environment, there needed to be greater accessibility, better flow and an upgrade to living units. As a continuing care retirement community, Cedar Dell tends to independent living, assisted living and memory care residents.

Nestled on 10 acres of land, the community comprises 61 apartments that are a combination of studio, one- and two-bedroom apartments for assisted living residents, and 17 apartments for older adults with Alzheimer’s disease and other forms of dementia.

The $1.5 million renovation undertaken by South Coast Improvement Company of Marion, MA, consisted of improvements to all resident units, common areas and corridors, as well as with the construction of a new exterior walkway and a new elevator.

“We took their designs and made it happen,” says project manager John Alessandrini. “They had some nice finishes — one of the best is changing the location of a door that goes outside so that when you walk through the front door you see everything right through to the courtyard.”

The project also included fresh paint, new carpeting in multiple units, new lighting and flooring throughout offices and common areas, and the installation of a number of other new amenities on the property, including railings, cabinets, ceiling lights and handicapped shower benches.

All apartments were updated with granite countertops, new micro-fridge/ freezer/microwave combinations, new walk-in showers, fixtures and a combination of hardwood and carpeting. A pub on the first floor also got a makeover, and a new bistro for lighter fare dining options was installed on the second floor.

On the exterior, new concrete walkways were built for the courtyard along with new fencing for the main facility and an enclosed memory support courtyard as well, Alessandrini says.

“Overall, we affected every area,” he says. “We went about it in a very thoughtful way that was respectful to space, the facility and the residents.”

One of the biggest challenges of the renovation was the construction of the new elevator, which, besides being the first one the firm built, became extremely hampered by New England’s “winter for the ages” in 2015. A six-week snow siege in January and February broke all-time records, with February qualifying as the snowiest month in history, at 64.8 inches.

“No doubt about it, the winter weather was extremely challenging,” Alessandrini says. “The heavy snow caused a lot of delays. If we didn’t have the winter we had, the project would’ve taken four months. Instead, it was eight.”

3 LESSONS LEARNED

1. Clear planning is essential in getting a project going and on a pace for on-time completion.

2. Harsh weather can definitely be a factor in construction – especially during a New England winter.

3. Small changes such as a doorway being moved can result in spectacular sight lines and views outside.

Clinical leadership often operates in silos, noted Kelly Cronin, director of the Office of Care Transformation, Office of the National Coordinator for Health Information Technology. Care plan functioning should allow for task tracking, and data should be dynamically updated multi-directionally in real time, as well as become aligned, she said.

“The challenge in [long-term care and post acute care] is to think about partnerships,” Cronin said. “We need your involvement to get this right.”

Multiple care providers need to be able to see electronic medical information.

“We really want to make sure it’s not just doctors and hospitals exchanging data, but the whole care continuum,” she said.

CMS is working on a data element library with assessment data elements and linked HIT standards, which is expected to be available later this year, according to experts discussing the Improving Medicare Post-Acute Care Transformation (IMPACT) Act during a morning session.

Having the data element library linked directly to quality measurements is meaningful, noted National Association for the Support of Long Term Care Executive Vice President Cynthia Morton.

“CMS connected the dots for us,” she told McKnight’s. “It’s one thing to have data. It’s another thing to have that standard.”

Presentations included a case study from Evangelical Homes of Michigan, which created a program called LifeChoices. The customer pays an entrance fee of $40,000 plus a monthly fee of around $400, CEO Denise Rabidoux said. A navigator is assigned, with a care team working to keep the independent adult at home.

FOOT ULCER TOOL

Worcester Polytechnic Institute investigators have developed an advanced smartphone application, called Sugar, for those with diabetes. The app can measure status of chronic foot ulcers.

The app is entering a pilot clinical study at the University of Massachusetts Medical School. It was built by an engineering and technology team at WPI with wound care, diabetes and behavioral specialists at UMMS. The work is supported by a National Science Foundation grant.

The new app runs on Android smartphones and can integrate a patient’s personal glucose meter and scale to track blood sugar levels and weight, the research team said. It also tracks exercise and other physical activity based on user input, and can provide prompts. It could say, “It’s been five days since you last exercised,” for example.

The wound-assessment system uses the smartphone’s camera, which can track the wound area and then send the information to caregivers.

The pilot clinical study at UMMS will enroll 30 diabetic patients who are being treated for foot ulcers at the medical center’s wound clinic. Patients will use the app for approximately six weeks.

NEW INFECTION FIGHTER

Researchers have developed a dynamic “smart” drug that targets inflammation in a site-specific manner, according to a story in the Journal of Immunology. The drug has the potential to enhance the body’s natural ability to fight infection and reduce side effects. When injected, the drug is non-active; it will activate if inserted near an extremely inflamed area of the body.

TOOL AIDS WALKING

A new smartphone app, called CuPID, has been designed for patients with Parkinson’s disease who experience Freezing of Gait — brief episodes of inability to step forward. The app is a rehabilitation tool that provides external cueing for motivational training with audio feedback. Small sensors are placed on the patient’s shoes to identify deviations in their walking pattern.

TAKING HEART (IMAGES)

Two common imaging techniques have been integrated to produce a three-dimensional anatomic model of a person’s heart by researchers at Spectrum Health Helen DeVos Children’s Hospital. 

The 3D model printing of patient’s hearts has become more common recently as it can enhance diagnosis and allow more preparation for surgery.

A BETTER LOOK

Computer vision specialists are working to develop an adaptive mobile phone with a “smart” vision system embedded inside to help blind and visually-impaired people navigate unfamiliar areas. 

The team plans to use color and depth sensor technology inside smartphones and tablets to create 3D mapping, navigation and object recognition. The interface will be used through vibrations, sounds or voice.

MOBILE ROBOT

A new mobile robot to help people suffering from paralysis or limited mobility is in the works. The robot will be remotely controlled by the patient and will have a video camera, screen and wheels to enable it to film as it moves around.

EXPLORING GENETICS

Computer scientists have developed a new interactive tool to help researchers explore cancer genetics. The tool, Mutation Annotation and Genome Interpretation, is a web application that allows users to search, visualize and annotate data on cancer genetics.

 Viewers also can upload their own data and compare findings to larger databases. n Getting data to work across settings Finding ways to better share and integrate healthcare information was a hot topic at a recent technology conference that took place in Baltimore. “We really want to make sure it’s not just doctors and hospitals exchanging data, but the whole care continuum.”

The ANA cited a survey of 3,765 RNs that found almost one-fourth of respondents had been physically assaulted at work by a patient or a patient’s family member. The survey also found up to half of nurses had been bullied in some manner by a peer or a person in a higher level of authority. ANA’s statement defines bullying as “repeated, unwanted harmful actions intended to humiliate, offend and cause distress.”

The ANA’s new policy includes recommendations to prevent and handle violence like encouraging employees to report incidents of violence, avoiding blaming employees for violence perpetrated by non-employees and developing a violence prevention program aligned with federal health and safety guidelines.

“Taking this clear and strong position is critical to ensure the safety of patients, nurses and other healthcare workers,” wrote ANA President Pamela F. Cipriano, Ph.D., in a statement. “Enduring physical or verbal abuse must no longer be accepted as part of a nurse’s job.”

Violence against healthcare workers, especially nursing assistants, should be handled with more scrutiny by senior living organizations, according to American Association for Long Term Care Nursing Executive Director Charlotte Eliopoulos, RN, MPH, Ph.D.

“Studies have shown that more than half of certified nursing assistants [CNAs] are victims of assault and battery at least once every week,” Eliopoulos told McKnight’s. “Staff need to be better prepared to identify violence-prone individuals, prevent violent acts, and manage them should they occur.”

MISSING THE MARK

More than half of healthcare workers commonly miss parts of their hands when applying hand sanitizer, a new study has found.

Researchers investigated 705 clinicians working in their regular shifts who used an alcohol-based hand sanitizer mixed with a fluorescent marker. Workers’ hands were then viewed under a UV lamp to show where the hand sanitizer had been rubbed.

Results found that thumbs were the spot most often missed by sanitizer, with only 37.45% of clinicians completely covering the area. Fingertips and the back of hands rounded out the top three “missed” areas, with just 44.5% and 46.4% of the study subjects completely covering the area, respectively.

Researchers found that the areas in between fingers were reached more regularly, with 74.8% of clinicians covering the area with sanitizer. Palms ranked highest in sanitizer coverage, with 98.9%.Full results appear in the American Journal of Infection Control. 

READMISSION RISK

Seniors are more likely to be admitted to a hospital after outpatient surgery due to misunderstanding discharge and medication instructions, a new study shows.

Researchers examined data from more than 53,000 Americans who had outpatient surgeries in 2012. Of that group, those over age 65 were 54% more likely to be readmitted to the hospital within 30 days than those younger than 65. Researchers did not include patients’ health before surgery as a factor in the study.

“Age was the biggest factor associated with readmission and complications,” said study author Gildasio De Oliveira Jr., M.D., assistant professor at Northwestern University’s Feinberg School of Medicine. “It’s not because they are sicker. It’s because they are older and have trouble understanding their discharge instructions and medication dosing, which often are not clearly explained.”

CONVERSATION STARTER

A new guide has been developed to advise physicians on having end-oflife conversations with patients and their families.

The “Serious Illness Conversation Guide” is composed of seven questions that focus on helping patients understand the reality of their medical situation without causing emotional distress. Questions include the patient’s concerns and fears, and factors they believe are important to their quality of life.

The guide, which was developed through a collaboration between Brigham and Women’s Hospital and the Harvard School of Public Health, is in its second year of efficacy trials. After four years of research, experts hope to determine if the guide helps physicians and patients have more conversations about end-of-life care, and if those conversations take place earlier in the progression of the patient’s disease.

IMPROVE TOOLS

MRI scans and other tools used to confirm dementia need to be improved, say investigators.

Study co-author Chris Fox noted that healthcare costs could rise without cause as imaging shortcomings lead to incorrect diagnoses of dementia. Moreover, the psychological costs to patients and families as a result of failed findings could be psychologically devastating, he added. Full findings appear in The Lancet Neurology.

FLU SHOT GUIDANCE

Seniors should be vaccinated for the flu before December, according to new vaccination recommendations from the Centers for Disease Control and Prevention.

The influenza season typically peaks between December and February. For adults over the age of 65, the flu vaccine’s effectiveness can decline “significantly” in the months following vaccination, the CDC noted.

Multiple property portfolios and large scale third-party management companies have significant economies of scale and can implement the necessary strategies to keep up with changing trends. The future challenges for individual self-managed operators involve two key time frames: 1) short-run, what must operators consider in the next 18 to 24 months? and 2) longer-range, how can they address the future in at least a 24- to 60-month time frame?

Typical examples of current and future needs include: sophisticated systems and procedures; comprehensive; and expanded business practices, growth and expansion of information technology, and increasing sophistication of prudent business operations including bench marking, sales and marketing, human resources, risk management,and enhanced purchasing power. One issue is very clear: Financial viability and available cash flow must be enhanced in order to procure additional services, resources and professional advice and counsel. The trends of increasing minimum wage also will impact entry level workers.

There are four basic property management options for senior living communities: 1) individual self-management; 2) purchase as required, short-term third-party management company services and resources while sustaining full self management autonomy; 3) procure selective management support on an ongoing basis from either local providers or through a negotiated contract with a full service, third party management consulting firm, and 4) full scope long-term outside management support.

Most self-managed operators desire to remain in complete control. That’s understandable. But it will be increasingly difficult to achieve. Some not-for-profits and for-profit operators may think they are somewhat immune. That’s not true. To remain successfully self-managed in the future, sponsors and owner/operators must essentially create the same service mix and resources that they might otherwise get from a qualified third-party management company.

Here is but a sample of some existing and future self-management issues to address. There are actually about 25 that will surface in the next five years:

1. Systems, Procedures and Policies — Having sophisticated, yet practical, and cost-effective systems, software, operating strategies, controls and performance enhancements.

2. Achieving Economies of Scale — Realizing the potential for creating significant ongoing operations and procurement economies of scale that deliver substantial (and necessary) financial benefits to an individual community.

3. Staying on the Leading Edge — Sustaining the ability to stay on the leading edge of the state-of the-art in operations strategies and technology in an ever-changing complex industry.

4. Providing Innovative Operating Strategies — Executing cost-effective, consistent and focused market positioning, sales and marketing initiatives, along with cost-effective operations that result in high resident satisfaction and clinical excellence.

5. Risk Management Steps — Having leading-edge risk management knowledge, experience and systems. Contractual and resident care litigation will continue to increase along with potential cost exposure.

6. Succession Planning — Operators must recognize that leadership can change by both planned and unpredictable events. Developing existing “bench strength” with existing staff also will be a mandatory initiative.

7. Growth In Community-based services — Progressive communities are creating an expanded seamless continuum beyond their campus into their Primary Market Areas. This generates additional revenue and sharpens the image and market positioning of the original senior living campus.

8. Enhanced Organic Growth —That’s a fancy term for expanding service delivery and financial proceeds from an existing asset — the current community.

9. Increased and Sharpened Board Involvement — Board members should no longer be selected or retained as an honorary position. Boards should be carefully diversified based on specific experience and the ability to directly benefit the community on a continuing basis.

The complexity of the senior living business has increased substantially in the past 10 years. This trend is projected to dramatically increase over the next 10 years. A frequently used cliché is still very appropriate: “Evaluate the past with 20/20 hindsight . . . look to the future with an entrepreneurial vision.”

Jim Moore is president of Moore Diversified Services Inc., a national senior housing and healthcare consulting firm based in Fort Worth, TX. He has written several books about assisted living and senior housing, including Assisted Living Strategies for Changing Markets. A new book, Independent Living and CCRCs, is now available. He can be reached at (817) 731-4266 or jimmoore@m-d-s.com. “Most self-managed operators desire to remain in complete control.”

Just this May, an 86-year-old senior living resident with dementia wandered away from the facility and into the street and died after being struck by a car. Such devastating events are hardly isolated; however, experts agree they can largely be prevented with a comprehensive resident safety plan.

“Taking measures to improve safety can prevent injuries and help a person with dementia feel more relaxed, less overwhelmed and maintain his or her independence longer,” the Alzheimer’s Association notes.

Senior living operators are clearly taking note. Many are designing thoughtful indoor and outdoor spaces that encourage safe wandering. Furthermore, they are providing ongoing staff education to help identify at-risk residents, and developing individualized care plans to reduce the risk of dangerous wandering, falls and elopement, according to experts. 

As an added layer of protection, operators are employing modern, discreet and unobtrusive wander management solutions that let residents roam safely, promote autonomy, and promptly alert staff to falls, elopement, behavioral changes, or other events.

“The promise of technology is in preventing bad things from happening and/or facilitating the appropriate response if an emergency occurs,” says Mike MacLeod, president and co-founder of Status Solutions LLC.

The days where wander management required loud alarms and institutional door lock-downs have become a thing of the past. They have been replaced by smart, innovative solutions that include low-profile door controllers with discreet keypads that seamlessly blend with the residential setting, and resident-worn bands, pendants and tags that can be set and adjusted to meet residents’ unique and evolving needs. 

“We believe if you enter a dementia care area with wander management and you notice the emergency call system, whether it’s audio with buzzers or alarm announcements, or visual with flashing lights and such, the system is outdated,” notes CISCOR CEO Sam Youngwirth. “Systems should blend into the environment and should not induce stress to the resident.”

A basic, intelligent wander management solution will include a transmitter for the resident to wear, and sensors at each of the doors to sound an alarm when the monitored resident approaches. Entry-level systems won’t do much beyond sounding the alarm, and possibly locking the door, preventing the resident from eloping, points out Laurence Yudkovitch, product manager for RF Technologies. 

“While this satisfies the basic requirements for protecting at-risk residents, it does so at the expense of adding noise to the environment, and still requires a caregiver to be within earshot of the alarm.” 

Smarter, integrated solutions include remote alerting capabilities, allowing the caregivers to be anywhere in the facility and receive a page, SMS or email if a monitored resident elopes. 

“By reducing or eliminating the audio alarm, these systems improve the ambience of the facility, decrease disruption to other residents and free up caregivers to perform other activities,” Yudkovitch notes, adding that aesthetics are also part of modern-day wander management solution design.  RF Technologies’ Touch Pad Exit (TEC) controller, for example, turns off the backlight when not in use, so it blends into the background and helps promote the home-like feeling. Similarly, facilities can forgo the bulky black transmitters residents wore in the past and opt instead for discreet, lightweight transmitters that are as comfortable as a wrist watch and feature calming, colorful designs. 

Many of the latest wander management solutions also integrate with other resident security systems, such as emergency call, security and fire panels, telemetry, access control, mobile alerting and reporting systems, closed circuit televisions, and more. 

“The ability to integrate these systems has gotten easier over the last few years. Oftentimes, there can be significant savings by integrating these systems via comprehensive technology design that takes into consideration how care staff interact with all of the systems,” notes Wes Columbia, technology studio lead for Direct Supply Aptura. 

Enhanced integration and interoperability makes it easier than ever for staff to monitor alarms and security events, and then use that data to pinpoint resident patterns and provide more flexible, individualized care.

“As an industry, we’re moving from a reactive mentality to a much more proactive one of trying to get in front of an incident using predictive technologies,” says Youngwirth. “We know that when a resident deviates from their norm, the probability of an incident can increase.” 

CISCOR’s system helps caregivers learn individual resident patterns and sends an alert when a resident deviates from his or her norm. This allows caregivers to intervene before an event occurs.

Customized alerts are also paramount to providing personalized resident care and response. As part of the Code Alert Wander Management system offered by RF Technologies, model T80 TEC can uniquely identify each monitored resident at the door. 

Aside from allowing customized alerts that inform the caregiver which resident is loitering or eloping, advanced analytic capabilities in the software let caregivers track and trend resident behavior over time. This information can be used to detect changes in a resident’s condition, and help determine alternate care plans, according to Yudkovitch. “If a resident starts generating a number of loiter alarms consistently over a couple of days, for example, that can serve as advanced warning that the resident may be at a higher risk for eloping, and trigger the staff to create an alternate program to re-engage the resident.”

Video enhancements add another level of specificity to alerts. A facility can use video paging to visualize door alarms to prevent elopement, says MacLeod. 

“Sometimes, residents with wander-prevention bracelets can trigger an alarm because they’re in the general vicinity of the door, not because they are trying to walk out. If staff can see that a false trigger has occurred, they don’t have to deploy resources to investigate.”

Giving caregivers ready access to real-time, resident-specific information from their smart technology — anywhere and at any time — enhances staff response that results in better resident care. 

“Care operators can assess, predict and report any incident from one central location, or from anywhere in the facility,” says Jack Zhang, CEO of CaerVision Global Inc. “With facial recognition, voice activation and wearable devices, senior living organizations can remain confident that residents will no. [engage in unsafe wandering].” 

CaerVision recently acquired Vitall Inc., a provider of resident safety and monitoring technology. Vitall’s wearable, in-room monitoring solutions provide round-the-clock emergency support from a centralized facility. The technology controls security access/entry, intelligent environmental controls for lighting and room temperature, CCTV, data/voice communication cabling, datacenter management, wireless infrastructure, and audio/visual controls.

Wander management solution providers also are taking advantage of increasingly budget-friendly and reliable real-time location systems that can be used in both indoor and outdoor applications. In some cases, the technology offers an alternative to obtrusive door locking and disruptive anti-elopement alarms. 

“An effective RTLS solution, while allowing residents the freedom to move freely throughout a facility, can ensure residents’ safety by providing detailed — and often quiet — real-time scenario notifications that are distributed to conveniently located staff and/or nurse stations,” says Rachel Owens, VP of product management for PointRF. “This enables situations such as an unsafe area entry to be addressed quickly, before an event occurs.”

Add-on accessories can further enhance the data generated by an RTLS solution. Internal pedometers and accelerometers in wandering bands that are part of a building-wide RTLS, such as the PointRF NoWander platform, can provide ambulation trend information. 

This can play a role in fall risk management and therapy needs assessments, according to Owens. 

Yet however advanced today’s wander management solutions may be, experts agree that their benefits won’t be realized if staff aren’t doing their part. 

The bottom line, they say, is that staff must be committed to analyzing captured data to drive improvements and provide the most appropriate, resident-centric care. 

“If a resident has a propensity to ‘go home after work’ as the sun is going down — a common issue for many residents — staff can use that information to structure activities during the time following dinner,” says Columbia. This allows the resident to stay active and engaged, while reducing the risk of elopement. 

Staff also must understand that technology can’t do its job effectively without human intervention. “What if the batteries on the resident’s device fail? What if [the resident] gets out the door with a visitor? What if they ‘crack the code’? These are things to consider,” cautions Eric Masters, VP of marketing for Relias Learning. He also points out that staff should rely on their training to determine who is at risk for elopement or wandering to another section of the building, and what they must do to help return a resident to their designated area. 

“Education and awareness, as well as adherence to company policy and manufacturer instructions on technology upkeep and maintenance, may be even more important than the technology itself,” Masters says. 

Data gathered by the National Institutes of Health underscores why senior living operators need to consider the effects of Alzheimer’s disease and dementia: 29% of residents have been identified as having mild cognitive impairment, 23% have moderate and 19% have severe cognition challenges.

“That research is from 2014, so this is recent data showing a significant number of people living with some form of dementia in these facilities,” says Kathleen Weissberg, education director for Select Rehabilitation. “Assisted living is feeling the shift more than any other sector.”

To the sector’s credit, operators are recognizing the situation and responding by adding memory support wings, building therapy gardens and implementing new programs to help residents live with cognitive impairment. Yet there are some major steps that still need to be taken, Weissberg says. 

“The residents should be in charge of the activities they participate in and they aren’t,” she says. “Facilities are still focusing on basic care needs and less on leisure pursuits. As a result, they are pigeonholing residents into available activities instead of asking them what they want to do.”

One of residents’ chief complaints about their facilities is “lack of control” over their activities, Weissberg notes, suggesting that the key to solving that problem is simply asking residents about their interests.

“Find a way to make it happen — everyone has a passion, so make an effort to identify what it is,” she says. “It could be beer or wine tasting, chess, or even beekeeping. Get creative and involve everyone.”

Weissberg is an adherent of the Canadian Occupational Performance Measure, an evidence-based outcome measure designed to capture a client’s self-perception of performance in everyday living, over time. That model recommends engaging residents daily about their priorities and activities focus.

“If they’re focused on what is meaningful to them, it results in better attitude, health and outcomes,” Weissberg says. “Meaningful activities maximize benefits — they give residents a sense of purpose.”

Cognitive engagement

The memory support field is indeed evolving and the senior living community needs to be apprised of the new tools available, says Lori Snow, marketing director for It’s Never 2 Late.

“There is greater demand not only for cognitive therapy but for cognitive engagement,” she says. “The next generation of cognitive programming includes therapy, lifelong learning and recreational enjoyment … and technology is a big, if not the main component of that cognitive programming.”

A comprehensive program should include “person-centered” engagement and therapy performed with the new sophisticated tools and products available, Snow says. At its heart, the program must function with “the understanding that dignity and age appropriateness matter,” she says.

As an increasing number of residents with cognitive impairments enter the senior housing sector, Snow says facility operators need to take a hard look at their programs to determine if they are serving residents’ needs properly.

“As dementia hits closer and closer to home, it becomes easier to assess, a little more real when we ask ourselves ‘Would my parent be comfortable with this or would I want to do this myself?’” she notes.

Interdisciplinary effort

Occupational therapists tend to be the program directors within senior living rehab programs, but memory care also should include a physical therapist and speech language pathologist to ensure all aspects of the resident’s condition are considered, says Kristy Brown, president and CEO of Centrex Rehab.

“We spend a tremendous amount of time training caregivers to get clients to participate more in daily living skills, ambulation, swallowing and speaking to the best of their abilities,” she says. “After we are alerted to a marked change in their performance, we get involved again to determine the levels of performance and provide appropriate training for the caregivers.”

Overreliance on what one single therapist says offers only a one-dimensional perspective, Brown says, while an interdisciplinary team “brings distinct specialties to develop a plan of care that best meets of need of each person. The input of everyone, including the aides — who see the client more often than other staff — is essential in the overall care plan for the client.”

Partnering with a wellness coordinator to carry out strategies for each resident also is optimal, observes Judy Freyermuth, physical therapy national clinical specialist for Rehabcare.

“The wellness coordinators who are working with the residents on a regular basis also assist in recognizing further decline, need for modifications to the approaches or referral for more skilled intervention,” she says.

Freyermuth identifies key program personnel as speech, occupational and physical therapists, activities directors, nurses and administration. 

“There may also need to be involvement from maintenance, for example, if modifications need to be made to the environment,” she says. “Based on the setting and resident, different members of the IDT would need to be involved to varying degrees.”

Together, the team can devise therapies that are at the appropriate cognitive level for the client, fostering enjoyment and satisfaction from the activity, Brown says.

“When they know how to interact with the activity, it allows clients a feeling of freedom and accomplishment they wouldn’t have felt if it had been at a level beyond their comprehension,” she says.

There’s a traditional wingback with high sides supportive enough for an afternoon snooze, a second version of the same chair that offers an easy-tilt back, and a third that allows for gentle rocking.

There are no clumsy handle mechanisms and no traditional rocker legs to trip over, and yet the chairs don’t look — or act — like boring, old overstuffed recliners.

“We have a lot of different needs,” says Andrea Owensby, senior director of interior design for Sunrise. “Some people in our aging population like harder or softer surfaces, some like a snugger space or the ability to spread out if they want to.”

Sunrise spent six months perfecting the modified chairs with one of its preferred manufacturers; the hope is that they will be popular enough with residents to roll out to other communities across the country.

It’s one example of how customization is providing options to long-term care communities.

No longer satisfied to buy pieces designed for the hospitality industry, larger providers are pushing companies to design with seniors in mind. That requires a careful balance of form, function and fashion.

It also requires smaller providers to keep pace if they expect to compete for residents. A growing number of manufacturers and designers is working with long-term care clients to improve ergonomics and aesthetics, lengthen the lifeline of key pieces, and ultimately, make residents feel good.

A few years ago, architect Dean Maddalena couldn’t furnish senior living spaces the way he designed them because most flooring and furniture selections that worked visually didn’t satisfy the day-to-day needs of his clients.

He designed his own line, studioSIX5, now being produced by Kwalu. The pieces feature a transitional style that he describes as “traditional yet sophisticated with just enough edge to be cool.”

Each piece is designed with specific seat depths, arm heights and wetness barriers, but that doesn’t mean a visitor would know it to look at it.

“Our clients want those baby boomers, a resident’s 57-year-old daughter, to come in and say, ‘Wow, I could live here.’” Maddalena says. “They do not want to go to a skilled nursing home. They want to go to a care environment that reminds them of staying at a W Hotel.”

Tech transformation

There will be more pressure to make products more tech-friendly.

Jack Armstrong, a former executive vice president for Cooltree and a furniture industry consultant, expects there will be a shift away from reducing costs and a return to features that add value.

“Over the last 10 years the economy has suppressed innovation,” Armstrong says. “The focus was on reducing manufacturing cost to lower the sale price. Over the next 10 years the economy will improve and innovation will increase.”

Jon Lucas, president of CIT Commercial Services, a financial holding company, said much the same in his 2014 “Viewpoint” on the furniture industry. Though color and arrangement are evolving, so, too, is the use of technology.

“Furniture is being tied into some of the hot and newer electronics, whether it’s the televisions or smartphones or the flexible and moveable stereo equipment that you can get today and run off of an iPad,” Lucas says.

The number of casegoods that incorporate charging stations will likely increase, as will the use of task lighting that features plugs for residents’ devices.

Furniture made to house electrical cords likely will play a bigger role in the healthcare segments as aging patients bring in more of their own mobile devices. Technology that makes life easier for residents also is a plus, says Owensby. 

Sunrise uses touch lamps throughout many of its communities, while some rooms have on/off switches triggered by movement.

“All of this innovation is under the umbrella that the price/value equation is still king,” says Lucas. “The consumer is still looking for value.”

Material differences

FlexSteel has provided furnishings to the long-term care sector through its healthcare unit since 1983. Although his company has a reputation for durability, Vice President Mike Santillo says FlexSteel continues to investigate options that might open up new price points. 

Within two to three seasons, Santillo expects to have three lines that offer customers a choice between all-wood, all-steel and mixed-material products. FlexSteel is also working to reduce the weight of some its products because many end-users want to be able to move them without much labor.

Although he recognizes the financial crunch many long-term care operators face, he says his company hasn’t found cheaper extrusions or plastics to work nearly as well.

“There is a lot of movement in materials right now,” Santillo says. “But plastics are not the answer in this senior living environment. It’s not warm, and it tends not to be as durable.”

For the last 25 years, Sunrise has leaned heavily on the formal dining chairs — delicate arms, turned legs — once thought to be admired most by seniors. But the company is trying out steel-framed chairs in about 30 of its memory care units, where Owensby says the traditional chairs were taking the biggest hits.

The wood-look chairs come at a higher price point, but save the effort of constant re-staining. They are also holding up longer, a point Owensby says is critical to operators of healthcare facilities.

Maddalena also is concerned about durability. His line features a wood-look finish, sometimes with metal ferrules that cover the bottom three to six inches of legs to ward off vacuum cleaner and walker damage.

Armstrong predicts chairs with easy-to-replace upholstery will become a common feature, allowing providers to get longer lifespans and save money over 10 to 20 years. In casegood manufacturing, he says 3DL surfaces (or thermoplastic film overlays) will become more prominent because they provide seamless, rounded corners and look like wood without the cost of wood.

“It is also easier to clean and disinfect,” he says. “Because of the increased design capabilities, it can incorporate features like spill retention barriers.”

We have seen healing—a lot of healing—and a lot of acceptance of the past and present. People have found purpose. People who hadn’t felt as if they had anything to contribute have created beautiful pieces of art. We launched our new art therapy program late last year to benefit our residents, and it has had a significant effect on many. 

Working with me as I oversaw the program was Kylin Jewell, a master’s degree student from the School of the Art Institute in Chicago, who worked as an intern here, introducing art therapy to the residents. She worked with a variety of residents, both individually and in groups, including our Living with a Loss group, with members who are residents dealing with the loss of a loved one or a loss of an ability or mobility. Kylin also worked with residents with dementia and residents whose health is changing.

Although participants might learn a skill in art therapy, that’s not the purpose of the program. Rather, the purpose has to do with the process. The art becomes the healing vehicle for the person’s life, a way for them to access and express feelings that are difficult to convey in words.

The art therapy sessions were run in several different ways. Kylin worked with a group of residents in a designated art room, and at other times, she worked individually with residents in their apartments. Sometimes a resident would talk while creating, sometimes he or she would be silent while creating and then would talk about it afterwards. Sometimes the resident would tell a personal story, and sometimes the art piece would tell the story.

As beautiful and compelling pieces of artwork began to emerge, we made the decision to hold an art show, exhibiting a sample of the creations. The idea evolved into an intergenerational art exhibit called The Art of Friendship, which was held in April. We began with an idea of an art show by the therapy program, but then other things started happening. Friendship Village has a long-standing collaborative relationship with the neighboring Hoover Math and Science Academy in Schaumburg. This year, a group of residents partnered with Hoover’s photography club. Part of our art show featured this collaboration. We then opened up the show to students in the fourth and sixth grades to display some of their work as well.

We then decided to invite all artistic residents at Friendship Village to contribute a piece to the show. We had a great response from our residents. We had a wonderful variety of pieces, including sculpture, photography and painting.

I hope that art therapy is a constant offering at Friendship Village. I think it’s cutting-edge right now, and we’ve been able to put together a quality program bringing together the different pieces that benefit our residents and their families.

Shawn Kafader, LCPC, is chaplain and clinical counselor at Friendship Village of Schaumburg. Friendship Village is a 35-year-old Chicago-area retirement community offering independent living garden homes and apartment homes as well as assisted living, memory support, skilled care and short- and long-term rehabilitation services. For additional information, visit www.FriendshipVillage.org.

The report’s findings “highlight that the workplace is a unique place to tackle dementia,” Graham Stokes, global director of dementia care at Bupa, an international provider of specialist dementia care and supporter of the report, said in a statement. “With almost half of the world’s population in employment and people staying in work for longer than ever before, employers have a responsibility to act, as they have the potential to make a huge difference. They can support people living with dementia and their carers, and also encourage healthy lifestyle changes which may reduce the risk of dementia.”

According the report, titled “The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends,” about 46.8 million people around the world currently live with dementia, with numbers projected to nearly double every 20 years, increasing to 74.7 million by 2030 and 131.5 million by 2050. More than 9.9 million new cases of dementia are diagnosed each year worldwide; that’s one new case every 3.2 seconds. Also, the report states, the current annual societal and economic cost of dementia is $818 billion, and that amount is expected to reach $1 trillion in three years.

The updated estimates are based on new research, led by Martin Prince, MD, of King’s College London, which considers both the growing numbers of older people as well as new and better evidence on the number of people living with dementia and the costs incurred.

Alzheimer’s Disease International makes these and other recommendations in the 2015 report:

• Primary care should be the key part of the health system to respond to the dementia challenge.

• Investment in dementia-related research should be increased so that it is proportionate to the societal cost of the disease. Research should be balanced among the areas of prevention, treatment, care and cure.

• Every country should develop its own national dementia plan or strategy as a framework for action across government sectors, and countries regularly should monitor the results and renew their plans.

• A Global Dementia Observatory, coordinated by the World Health Organization, should support and monitor policy development; monitor the scale of the epidemic; assess opportunities for prevention, their implementation and impact; and monitor progress toward increasing the available resources for treatment and care, and their coverage worldwide.

• Leadership of the G7’s Global Action Against Dementia should be transferred to the G20 group of nations.