Choosing a Nurse Call System for Your Senior Living Facility
There are approximately 16,000 nursing homes and Skilled Nursing Facilities, and over 33,000 Assisted Living Communities in the United States today. The number of Independent Living Communities is hard to determine because they are largely unregulated. In most cases these buildings have a facility wide nurse call system so a resident can notify staff by pressing a button or a pendant that they are in duress. The level of care may determine what the system is called.
In Skilled Nursing Facilites they are almost always called a nurse call system. In Assisted Living Facilities they tend to be called emergency call systems or call systems. Residents in this level of care don't like the negative connotations when the term nurse is added. In Independent Living they are generally called PERS (Personal Emergency Response Systems.) In independent living they even get confused with Individual subscription systems like Life Alert or Philips Lifeline which residents add to their phone line, pay a monthly fee and it will dial an outside line to check on the person. Nurse Call Systems are required in Skilled Nursing Facilities, but requirements in Assisted Living Facilities vary from state to state. Since Independent living is not regulated there is generally not a nurse call requirement unless the project has Federal dollars involved and has been required by HUD to install one. This article deals with choosing and implementing a call system in your facility.
As an owner or an operator of a senior living facility you should be making an informed choice about the call system you will be installing in your building. Many owner operators seem misinformed that all call systems are alike and base the purchase almost solely on the initial front-end costs. In my experience with new facility construction or remodels, many times the choice of the call system is left to the architect, electrical engineer, low voltage contractor or general contractor. The problem with this approach is architects and engineers don't have expertise in the all the different systems. They tend to recommend systems they have used in the past based on brand recognition without regard to actual customization. Low voltage or electrical contractors generally pick systems they get financial incentives for by becoming part of the call systems manufacturer's dealer network. General contractors choose the lowest cost alternative that will work. As an owner or operator choosing the lowest initial cost system can haunt you years down the road.
Reasons for Implementing a Nurse Call System
Skilled Nursing
- They are mandatory and may give you efficiency gains requiring less staffing.
- A more advanced system may be a marketing tool.
- Reporting capabilities for family’s peace of mind.
Assisted Living
- It may be mandatory
- You have to have one for marketing purposes because your competition has one.
- Reporting capabilities.
- Independent Living
- Marketing
- Risk Management - What are the effects to your bottom line or reputation if an emergency happens and a resident cannot get help in a timely manner?
- Incremental Revenue - your residents may be using a fee per month telephone service that typically calls your staff anyway. In this case you case you purchase a system, charge them the monthly fee and create a new revenue stream. Typically, the break-even point is between thirteen to thirty months not taking depreciation into consideration. Your census is the biggest variable in this scenario.
Making an Informed Decision
If your facility is large enough, you should at a minimum have a team with representatives of your administrative, clinical, maintenance, training, construction, operations, marketing and IT departments. The representatives should all have input on which system to proceed with. Administrative members will generally give input on financial considerations like total cost of ownership. Clinical and operations members will be concerned with the reporting and functionality of the system. They may even give you insight to where you will gain dollars back from efficiency gains. Training representatives will give you insight into the ease of use and along with the maintenance team your ongoing operating costs. Marketing gives you insight into census gains you can make against your competition. Finally, IT will be able to determine your networking and integration capabilities.
Consider at least three to five manufacturers of call systems in your initial search and try to answer some of these questions:
Does the manufacturer sell direct or use dealers. Who services the equipment the manufacturer or dealers?
National Call Systems, Inc. is a distributor for Smart Caregiver Corporation. Equipment repairs are handled by the manufacturer. 95% of our products have a 1-year warranty (some bed and chair pads have shorter warranties.)
How many systems have they installed? How long have they been selling this equipment?
As of Nov. 2009 National Call Systems have over 350 central monitoring units sold and has been a distributor for Smart Caregiver since 2007.
Will the dealer or manufacturer likely be around five years from now with support? Do they manufacture the equipment? Are we buying old current or Groundbreaking Technology?
The baby boomer population is only getting older! We don’t plan on going anywhere. Besides, wireless technology is only getting better and cheaper – with Smart Caregiver leading the way.
Once you have answered these questions you can then begin to look at the options that are available.
Call System History
Basic operation
A call system works like this: a resident presses a device that audibly notifies staff to attend to that particular resident. The next type of system is a visual call system. An example is a pull cord usually hung in bathroom and other rooms in the living quarters of a resident. The wires from this switch run back to the central board. When a light goes off on the board staff knows what room to respond to. The upgraded version of this system will add corridor lights outside the residents room. This is style of nurse call that has been around for fifty years. These systems tend to be the cheapest option during new construction but do nothing more than turn a light on or off. Since wired call systems may be over thirty years old, cost issues arise when the wiring fails, the facility wants to remodel or expand, or a facility wants to add reporting capabilities.
Wireless Call System Operation
Newer technologies using wireless call systems are now available. Wireless call systems add the added benefit of mobile devices such as pendants or the ability to connect bed or chair alarms and have the ability to have the alarms work in covered areas of the building or grounds. The term covered areas of the building is used because back of the store areas generally do not need coverage unless a facility is concerned about security. Some facilities are campuses on large acres of land so they may only choose to have coverage on outdoor patios, gardens or walking trails. Wireless call systems are easily scalable to suit the small building to the large campus. Wireless call systems use a network of antenna devices that send the signal back to the head end equipment. Wireless call systems usually have the benefit of being supervised, which means the facility is alerted if any of the devices fails. They will also usually have battery backups for devices that are plugged in so they can still operate if the power fails. Wireless systems are also let a facility add devices at anytime. In addition the devices can be easily moved in case the furniture is moved in a room.
Today, mid-range wireless systems require staff members to physically go to the device and reset the emergency call device. This ensures staff does not reset an alarm remotely without checking on a resident.
Infrastructure
UL 1069 - Wired systems are almost always UL 1069 compliant which is the regulatory standard for almost all systems in hospitals. There is a new UL 1069 standard for wireless call systems in the seventh edition. The new standard basically calls for system that supervises the devices every ninety seconds. This means the device tells the computer I'm here and working every ninety seconds. If not, a device fault would be sent to notify your staff.
Smart Caregiver Central Monitors supervise the device every 5 minutes, thus it is not UL 1069 Compliant. However, you will be alerted if/when the battery dies.
Basic Infrastructure
Wired system infrastructure is pretty straight forward two lead wires are run back to the annunciator panel from each device. Some newer systems will use category 5 computer networking cable, but those are usually found in hospital environments.
Today there are three major types wireless infrastructure 315 MHz, 900 MHz, and WIFI.Both 315Hz and 900 MHz systems use a network of one way antennas that blast the signal back to the head end. Most systems. While these systems tend to be reliable, if one of the antennas go down in this scenario you could possibly lose part of your coverage. In the majority of cases 900 MHz systems are made offshore by a company called Inovonics. Other dealers and manufacturers either private label or remanufacture this product. It is unclear this time if this product will be able to get to the UL 1069 seventh edition ninety second supervision requirements. You may want to ask if you are required to have UL 1069 if a wired call system is necessary as part of the system.
Locating capabilities for pendants worn around the neck usually works in two ways for these systems. You have to buy additional locators. However the locator is not a point, it is a sphere. You can get bleed through exteriors and other floors meaning a resident could be on the second floor but get picked up by a locator on the first floor. The second way is using transceivers or repeater/locators a computer algorithm tries to triangulate the nearest device to give location. Windows, wall construction, and RF noise can give you false readings. For instance I was once at a facility where the signal went out a window across the pool through another window in the opposite wing and would report their even though there was a locator in a nearby hallway closer. Neither choice helps with staff efficiency.
The latest systems designs are using WIFI infrastructures. You are probably familiar with WIFI from your wireless network at home. With a call system a network of routers is set up in your building to allow for communication. WIFI is built to have enough bandwidth for voice, data and multimedia.
WIFI systems have two way communication between devices meaning you can now get location down to room level if you want for pendant or mobile devices. The devices are lower power and typically there are more of them. The pendants look for the nearest router to tell them where they are and passed from one router to another as you move through the building. It might be comparable to cell towers making handoffs as you drive down the highway. If you want location capabilities the best choice today is a networked system. It is a byproduct of the two-way communication built into the system. The networks are also self healing so you shouldn't lose part of your coverage area in an emergency. The systems may be able to integrate with other systems using the same standards. They both appear to be able to design to get the UL 1069 rating. Make sure you check with your vendor to be sure on these last two items.
Types of Call Devices
Most types of call devices are standardized across the industry.
- Pull Cord - Mounted to a wall with a cord hanging to the floor the device is easily activated by pulling on the cord.
- Wireless Pendant - A small mobile device usually worn with a neck lanyard, a belt clip or a wrist strap. Residents can press the button and are not limited to the placement of bed cords or pull cords. If a resident is mobile pendants generally provide the best safety option for residents providing they will wear it. Many residents in independent living do not like wearing these devices.
- Call Button - Manufacturers have various types of buttons. Buttons are usually used in independent living to conceal the fact there is a call system which helps with resident dignity. They also are helpful in areas where a staff member might be the most likely person to be calling for assistance. Such as a beauty parlor. They may also be used as a concierge non-emergency device.
- Motion Sensors – these are mounted so when the laser is tripped by a patient falling out of bed or trying to leave the room, the alarm will sound to the caregiver.
- Bed and Chair Pressure Pads – These pressure pads will alert the nurse if a patient falls or steps out of bed. The technology improved on these so that there are fewer false alarms from a restless sleeper.
Reporting
When choosing a call system, whether wired or wireless should either have a computer included or the ability to easily add a computer without having to reconfigure your entire call system infrastructure. A computer allows a facility reporting capabilities. Reporting capabilities vary from manufacturer as the reporting capability is largely software driven. Reporting allows senior living operators to see which residents are calling for help the most and see how fast your staff is responding to the calls.
Call Notification - Advanced Options
Aesthetics, durability, and ease of use should always be a consideration when considering a new emergency call system. Industrial and institutional are the two looks to avoid. Once you have decided on the devices you want to use you should then consider how you would like this to report the information to your staff.
Corridor Lighting and Sound
As I mentioned before the simplest way to notify staff is with a bell but this also includes products that chime or ring. The next is to have an LED screen at a central or multiple locations can warn your staff of an emergency call. The next step would be to add corridor lighting and sound alarms. The problem with these systems today, as resort or home style living is the new paradigms; your competitors are removing the extraneous alarm noises and lights. This helps to make the building a more comfortable less institutional feel. In skilled nursing some states may still require corridor lights or large LED signs in the hallways as an alternative.
Nurse Pagers
Modern and cutting edge operators are employing alerting devices that let their staff become more efficient a mobile. The most basic device is a pager it simply alarms the appropriate staff with a simple vibration or tone that a resident has need that needs to be taken care of. Based on my experience, about eighty percent of the facilities using mobile alerting pager devices.
Response
There is certainly no boilerplate for responsiveness except to say every call is an emergency. Your staff needs to respond quickly whether it’s all hands on deck or designated caregivers. You need to make sure your vendor has enough experience to work with you and set up the system to work best for your needs. They should also be able to make changes as time goes on.
Service
The final variable to look at is service and support. Do they have phone and email support? And if they do is it free or do they charge for it. Can they help your staff add pagers or devices? In most cases with a wireless system your staff should be able to do this.
I hope I have helped you learn the essentials of picking out a call system for your building and why you shouldn't let others do it for you.
With National Call Systems, you will get a system that is:
- Easily Installed - Wireless systems are very easy to install. The monitor’s usually only need to be programmed to the central unit, tested that they are in range, and then attached in place with screws or double-sided tape.
- Scalable - Wireless Call Systems are scalable, so your system can grow with your needs. This also has the benefit of having a smaller upfront cost.
- Quick – Your system is practically up and running in a matter of minutes out of the box compared to wired systems which takes much more time, money, and effort to install. Your entire wireless call system will probably be cheaper than the labor charges of running the wires of a conventional system of yesterday.
- Uses Groundbreaking Technology – Wireless systems are quickly gaining ground in this digital age. Even our most basic unit has a 300’ range of the nurse call button. That’s a football field! This means up to a 600’ sphere of range!
- Is Dignifying for the Patient – The small wireless monitors can be mounted inconspicuously and out of the way so that your patient feels less “institutionalized”.
- Great Customer Support – We’ll offer phone support for first full year. If you’ve got a question, we’ll either know the answer or find out for you!