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How do you offer residents with dementia a safe living environment with as much privacy and independence as possible? How do you avoid unnecessary checks during the night? And how do you use movement data to improve care for the elderly? At Voltawerk in Gorredijk, part of ZuidOostZorg in Friesland, this is a piece of cake.
Published in ICT&Health, edition 4 – 2020
Technology only makes sense if it helps deliver the right care in the right place by the right person. This is the theme that runs throughout the innovation policy of ZuidOostZorg, a provider of home care, treatment and long-term care at 13 locations.
Hennie de Vries-Merkus says that Ascom’s Unite SmartSense solution was a good fit for this vision. As a nurse in geriatrics/gerontology, she works with the system, which uses sensors and smart algorithms on a daily basis. "It was a completely new way of working for us. We first used small poles with infrared signaling. They always work. But that’s both a benefit and a disadvantage, often with a false alarm. You don't know what’s going on in the resident’s room when a report is made. Now we have a much better idea."
At the Voltawerk site in Gorredijk, people with dementia live in a homely environment. There are four living groups of nine rooms and each living group has a cozy living room. All 36 rooms are equipped with sensor technology. Underneath the mattress is a bed sensor, which registers whether a resident is getting in or out of bed, and motion sensors in the sitting-bedroom.
For people with dementia, change is often very difficult. In the first few weeks, the care staff set up notifications without a delay. So, if a resident gets out of bed, they will immediately receive a message and can check whether everything is going OK. Once a natural routine has been identified after a few weeks, the delay can be set to 10 minutes or more.
“That means we don't have to be in someone’s room without warning unnecessarily,” says De Vries. "Not every resident benefits from having a caregiver at the bedside right away. This system gives people more space to go their own way, while maintaining safety. We cannot prevent someone from falling. But we don't want someone to lie on the floor for hours before they’re found."
"We always ask family members, or preferably the first contact person, for permission to use the sensors. There's never an objection. Often they say that the thought of their father or mother being watched over gives them peace of mind."
Introduction followed a pilot that started in 2018. Rob Hoogland, Solution Consultant at Ascom, knows that the introduction of a technological innovation like this requires attention. "We are a technically oriented company. So it is very important to train employees in advance and involve them in the innovation. Corien Veeneman, who was brought in as an organisational consultant for Ascom's implementations, has provided the care staff with guidance in this and has also been involved in the evening and at night."
The usual way of working in Gorredijk was: visit each resident a fixed number of times per night to see how it was going. 36 times door open, door closed. Until the next round. Suddenly, a system takes over. This didn't go well technically right away, Hoogland noted. "We therefore decided to temporarily activate the old infrared poles and take a step back. After that, technical improvements were made, additional training was provided, and eight rooms were switched to SmartSense. It was so good that the care staff themselves asked for expansion."
This was a completely new way of working for us. We first used small poles with infrared signaling. They always work. But that’s both a benefit and a disadvantage, often with a false alarm. You don't know what’s going on in the resident’s room when a report is made. Now we have a much better idea.
De Vries sees that the night shift is very good at using the system and that the day shift is well underway. "Sometimes there’s another call, which is deliberately not answered. Then I’ll tell you that you can turn them off in the system. Or we will discuss whether other settings are needed for this client. We are becoming increasingly familar with it. In each resident’s care life plan, we define which settings there are for the notifications. We also record changes. This way, everyone knows from each other how we monitor residents’ movement behavior."
All this data can help improve care, according to De Vries. "Take the woman who was helped to bed every evening at 9:00 pm. At night, she always got out of bed and was restless. We can then give anxiety medication, but we wondered: what’s the cause of that unrest? It turned out that she had been a farmer all her life. The farm was always so busy that she didn't go to sleep until midnight. After that, we changed the evening program and provide her with help much later in the evening. Calm is restored and there is hardly any need for medication. The good thing is that you can visually see this effect in SmartSense."
Data can also be used in other situations. Every two weeks, the Voltawerk team discusses residents’ problematic behavior. The system then provides an overview, which is more objective than a report that is written 'from memory'. De Vries: "For example, there is a woman who is disoriented in time. Then I open SmartSense and see that she had laid on her bed twice a week in the afternoon and also slept well at night. Or a man whom the team felt would be restless all night long. Then we can see at a glance: this resident was lying in bed from 11:00 pm to 3:00 am and walking around from 3:00 am to 6:00 am. So in situations like these we have a more objective view."
The starting points for the pilot were: an undisturbed night’s sleep for residents, freedom and safety for people with dementia and reduction of work pressure, especially at night. In the personal resident profile, a day profile and a night profile can be set, as well as a life circle for daytime and a life circle for night time. Camera images can also be added, in the corridors and living rooms at Voltawerk. In the SmartSense app, the images can be viewed directly.
ZuidOostZorg and Ascom will continue to evaluate the pilot, which has actually already been completed but for which development is still ongoing. For example, there is a desire to link data to the Electronic Health Record, which requires the cooperation of the EHR supplier.
ZuidOostZorg has coped well with the coronavirus pandemic. None of the residents became ill. If a resident had fallen ill, it would have been possible to adjust the personal resident profile, thereby limiting the number of contacts and maintaining social distancing. However, this is less suitable for these residents (people with dementia). Most people with dementia do not understand distance and would only become anxious about it if it was emphasized.
