A balance: independence & security

September 20, 2013 10:46 am
The staff of every assisted living facility deals with the same challenge: Ensuring the appropriate balance of independence and security for each of their residents.

One reason this is a challenge, of course, is that for each resident that balance is different.

For facilities that have memory care sections, designed for people with severe Alzheimer’s or other forms of dementia, that balance tips toward security.

It’s not uncommon for people diagnosed with dementia to wander away.

Exterior doors in memory care units are locked, with access usually controlled by a keypad code or similar technology.

This ensures that employees and visitors can come and go, but residents can’t easily leave and put themselves in danger.

The situation is different in assisted living sections, where some residents need little if any assistance but others exhibit early signs of dementia.

Here strategies vary among facilities.

In some cases the staff pays particular attention to residents who have symptoms of dementia, including frequent checks to make sure those residents are within the facility and safe.

Other facilities employ technology that can alert employees when a resident approaches or opens an unlocked door, giving staff time to make sure the resident hasn’t left the premises.

The Observer and the Baker City Herald interviewed officials from facilities across the tri-county area to find out how they approach this difficult task.

Vista Specialty Care and Wildflower Lodge, La Grande

Left unattended, dementia and Alzheimer’s patients have a tendency to wander and get lost, but two memory care facilities in La Grande — Vista Specialty Care and Wildflower Lodge — are using security technology that eliminates that risk.

Vista Specialty Care represents a skilled nursing facility for dementia and Alzheimer’s patients, said Emily Laprelle, executive director. Vista Specialty Care is a secure facility.

“What that means is that we have special (door) codes and appropriate staffing ratios to ensure that people cannot leave of their own accord,” she said. “Nobody can leave the door without the code. Any person who comes to visit, coming in or out the door or gate will trigger the alarm that tells us when someone is coming through any one of them.”

The facility also has the option of using a WanderGuard system with patient bracelets that sound an alarm if a patient leaves the facility; however, Laprelle said that with the security door codes, that technology is not used regularly.

“We have multiple systems set up here at the facility, and we don’t utilize (bracelets) regularly at this point because we already have enough safety intervention,” she said.

Community Relations Director Ann Yoder of Wildflower Lodge said its memory care unit uses similar technology.

“If they have a dementia diagnosis and they are in our memory care side, we have a keypad entrance, and they don’t leave that area without being attended by staff.”

Dementia and Alzheimer’s patients at Wildflower Lodge do leave the memory care side daily to participate in activities in the assisted living side of the facility, but they are supervised by staff the entire time. The patients are encouraged to participate in activities like bingo or one of their music groups.

“Our memory care side is called ‘Expressions,’ ” said Yoder, “because we have the different expressions we hit on on a daily basis — the spiritual, artistic and mental — all these different expressions.”

Offering quality of life activities to dementia and Alzheimer’s patients is a chief concern for facilities with a memory care community.

“We don’t want to just house people and say, ‘OK they have dementia’ and just shut them in here, but we help them continue to have an active life,” Yoder said.

— Trish Yerges, for WesCom News Service

Settler’s Park, Meadowbrook Place, St. Alphonsus Care Center, Baker City

On June 1, Meadowbrook Place, which has 40 residents, all in assisted living, installed the WanderGuard system on each of its 13 exterior doors.

“Our families are feeling very confident now,” said Julie Daly, Meadowbrook’s marketing director. “Our residents are safe.”

The greatest benefit of the system, Daly said, is that it allows residents to remain at Meadowbrook even if their dementia worsens.

In the past, because Meadowbrook does not have a memory care unit with locked doors, when residents reached a certain level of dementia they had no choice but to move to a facility with a memory care unit, Daly said.

“With the WanderGuard system people who have dementia can still live confidently and safely in an assisted-living environment,” Daly said. “It’s pretty exciting.”

Each resident wears a watch-like device that has secure, double-snap closures and contains a computer chip that triggers an alert to staff if a resident approaches one of the unlocked doors, Daly said.

The system also identifies the specific door, and employees have been trained to respond immediately and to “redirect” the resident, she said.

Settler’s Park in Baker City has 50 residents in its assisted living section and 24 in its memory care unit, called Expressions.

The memory care unit is secure, with locked doors that require a keypad access code to open, said executive director Jackie Wirth.

Staff and visitors have the code but residents do not, she said.

Although Settler’s Park’s memory care unit is secured, residents can always go outside into a courtyard that’s open to the air, but doesn’t have access to areas outside the facility, Wirth said.

Settler’s Park’s assisted living section is separate from the Expressions unit.

In the former, residents “can come and go as they please,” Wirth said — many continue to drive their own cars.

Residents do check out when they leave and check in when they return, which allows Settler’s Park employees to make sure no resident is missing, Wirth said.

In addition, staff members more closely monitor those residents who have exhibited signs of dementia. They are checked at least hourly, Wirth said.

Although no residents have wandered away from Settler’s Park in her two years there, Wirth said some residents are more prone than others to do so.

Yvonne Jones, the activity director for the Expressions memory care unit at Settler’s Park, said in a few cases a family member or other visitor has left a door unlocked. Although a few residents have left the Expressions unit, none has wandered away from the facility itself during her tenure.

Wirth said if the staff has any concerns that a resident has learned the keypad code, that code can be changed at any time.

St. Alphonsus Care Center is a 21-resident long-term care facility adjacent to St. Alphonsus Medical Center-Baker City.

The facility employs the WanderGuard system to ensure employees are notified if a resident opens an exterior door, which are not locked, said Alan Romero, the Care Center’s administrator.

“We don’t want people to wander off in a way that they would hurt themselves,” Romero said. 

— Jayson Jacoby, Joshua Dillen, WesCom News Service

Wallowa Valley Senior Living

Wallowa Valley Senior Living opened this summer in Enterprise, accepting residents for its assisted living wing as well as its memory care center.

Dave Harman, CEO of the Wallowa County Health Care District, said “Wallowa Valley Senior Living is a state certified facility for treating dementia patients with appropriate safeguards in place.”

Director Glenda Cummins said to ensure the safety of the center’s memory care patients, “We have a secured unit with a keypad entry in and out. There is an exit into a courtyard with a keypad entry and exit. In the event of a fire it unlocks like any magnetic door that would close and staff are in there all the time.”

The memory care unit has six residents with a capacity for 10, Cummins said.

Residents who need to be in the locked side of the facility are those who are a danger or risk to themselves or others and may head outside into the heat or cold, which is detrimental to an old person, Cummins said.

Cummins said a bracelet system was used at the former Wallowa Valley Care Center, but it did not work well. 

“When that system was installed people didn’t get the education to run it,” she said. “If someone got too close to the sensor by the front door an alarm would go off and staff would be alerted.”

She said the distance meter didn’t work properly and someone could be in their room and still set off the alarm.

 “When it was alarming all the time and no one was near the door no one was going to pay attention,” Cummins said. “It limited those residents from the common living area because it (the bracelet) would set off the alarm.”

Another problem was some of the exit doors did not have a sensor, though most of those had keypad locks. As for the front door, staff was always in sight of it as a safeguard, said Cummins.

At the new facility only staff has the codes for the keypads, though they are posted for visitors so they can get in — but posted backwards.

— Katy Nesbitt, WesCom News Service