The health-care market, and specifically the construction and renovation of nursing homes, continues to grow because of demographic trends associated with the aging of the United States population.
Within this market segment, assisted-living and independent-living homes, as opposed to what's called “skilled nursing homes,” (with more on-staff nurses and other health-care professionals) are growing fastest. In step with this trend, advances in nurse-call systems (referred to as emergency response systems in the non-skilled care sector) have improved to the point where an owner or administrator can easily and inexpensively incorporate call systems into every residential unit, adding value and fail-safe security to their property. The installation of these systems may be a new line of work for electrical contractors.
New wireless technology allows for the simple and rapid installation into any building, regardless of age. Relying on the latest wireless systems also expands communication options between residents and staff. Residents can request help through pendants worn around their neck or via room stations. Additionally, it is now a simple matter to set up a system so that when a patient sounds an alarm, not only will the bell and light go off at the reception desk (alarm master station), but the room location will be indicated on a display terminal and the person on duty can be notified of the situation via a pocket pager that beeps or vibrates up to a two-mile range. Such pagers can even be set up to notify staff when the alarm has been canceled. Modern software also summarizes all alarm and response data, providing written proof of reliable security.
Care that counts
These new wireless systems satisfy the communication and security needs of residents, and work well in the new types of senior-care facilities now being built.
“The industry is changing, and hardly anyone is building skilled nursing homes any more,” said Jerry Johnson, president of Cornell Communications Inc., Milwaukee, a manufacturer of hospital and personal emergency response systems. “There is now a tremendous demand for independent and assisted living homes. Aside from the improved health and increasing numbers of senior citizens, part of the reason for this popularity is that this industry is not nearly as regulated as the skilled nursing business.”
According to Johnson, even the recent building boom of “Alzheimer's homes” is beginning to wane in light of the greater demand for the less staff-intensive community care homes. Even if the staff assists residents with some activities of daily living such as preparing some meals and medication monitoring, this still requires much less time, and qualifications, than that required within skilled nursing homes.
Still, even the residents of assisted and independent living homes who don't require as much health care as residents in traditional full-care facilities occasionally run into trouble. They want to be able to summon help immediately from their homes, says Johnson.
“Independent seniors are driving, preparing their own meals, and when they need to see a doctor they most likely schedule it on their own,” he says. “However, they still expect to see some kind of emergency response system, like a pull string, in the bathroom at least. When most people don't feel well, they first go into the bathroom. Of course, the second biggest cause of injuries is people falling, and the most common place they fall is in the bathroom. So the customers know what emergency-call systems are, and where they should be located. If a facility lacks this convenience, they take up residence elsewhere, given a choice.”
To answer the growing demand for these systems, prospective owners and operators often times face the challenge of retrofitting existing residential homes, such as hotels or apartment buildings, to meet the regulations of caring for seniors. Yet, putting in an emergency-response system “after the fact” can present a daunting physical and financial challenge. Installation requires the boring of holes through joists and studs, tearing into the wallboard and tapping into overtaxed junction boxes that house outdated electrical components and stringing miles of wires through floors and attics.
“Even with a new structure, many times the owner is dealing with an architect who's never built a retirement home before, or an electrical contractor who's only dealt with wiring fire alarms,” said Johnson. “These individuals usually build apartment buildings or hotels and are not always equipped to simultaneously wire a facility for an emergency response system. Under such circumstances, putting in a wired system can still add up to a lot because now you have to bore holes in new walls and studs to string the wires. This extra expense can jeopardize the economic health of any facility.
“Another problem lies with existing nursing-home buildings that already have an older, outdated nurse-call system,” he added. “Typically, you have a hodge-podge of wiring. But there's a tremendous inspection process in recertifying a building, and one of the first things the inspectors look for is, ‘Is the nurse-call system working?’ To avoid huge fines of thousands of dollars per day, operators are finding it cheaper to install a new wireless system rather than have an electrical contractor trouble-shoot and replace all the old wiring.”
Because many individuals are unaware of the availability of wireless emergency-response systems, it's up to a facility owner or operator to specify them. However, some administrators are only aware of the old, wired nurse-call systems. Formerly employed within an acute or skilled nursing home, many will simply order the systems they used at the other homes, if only because they are already familiar with them.
The technology behind wireless systems is not that difficult to comprehend because in a basic layout wireless systems share some similarities with traditional wired systems. Each unit in a retirement or community-care home will have at least one room (usually the bathroom) with a wall-mounted, call-for-help station with a pull string — or a bedside mounted push button for activation of the alarm. Once activated, a buzzer, bell or light will go off at the reception desk to alert staff of an emergency.
However, by relying on ultra high-frequency radio waves, a wireless system allows through-the-air communication between a tiny wall-mounted (in any room) transmitter and the receiving station at the reception desk or directly to the staff via pocket pager. Typically, the master receiving station will be hooked up to a 110V AC source, but the transmitter/sending units only require a standard 9-volt DC battery, so they can be placed at almost any location. Changing or adding locations from a bathroom to a bedroom or kitchen can be accomplished in minutes.
“When you're talking about a 250-unit home, literally ‘miles’ of wire can be eliminated, since wires aren't needed to connect the transmitters to the receiver,” said Johnson. “Installation can proceed much quicker at less expense.”
Wireless systems also allow “non-fixed” sources of help signals. For instance, the Cornell system offers a small wireless pendant that patients can wear around their neck, wrist or within a pocket. Thus, wherever the patient may roam within the grounds of the home, he or she still can send an alarm signal to the homes' staff when necessary.
In all cases, the success of any wireless emergency response system, especially within a large building or a campus setting, relies on its ability to span large distances with a strong signal.
“One commonly used measurement is called ‘open-field range,’” says Johnson.
“This is the distance that the signal will travel across a open space. A typical system might cover 1,600 feet. Cornell makes a system that traverses 3,500 feet. Yet, an even better way to measure distance is referred to as the ‘rated range.’ It's a tenth of the open-field range. Now we are talking about the real world of going through walls within a retirement home. With this figure, an open-field range of 3,500 feet would yield a rated range of 350 feet. But since that figure acts like a radius, you could conceivably provide coverage over every inch of a building that was two football fields in length and 35 stories tall with a single, centrally mounted nursing station. That's more than enough to take care of any building.”
Johnson explained that it is the receiver's ability to receive the transmitted signal from the resident's room that really makes a difference in range and performance. A very sensitive, narrow-band receiver allows the emergency-response system to detect when a resident has sent/transmitted an emergency call, even when there is “noise” in the building.
Industry observers are looking forward to the day when call systems are mounted on every wall in every assisted or independent-living home in the United States. They believe consumer demand will help drive this market.
“In our building right now, we have a pull cord system both in the bathrooms and bedrooms of every single unit,” said Patty Logan, director of the Huntington Retirement Hotel in Torrance, Calif. “We are technically a community-care home, so it is not required by law that we have such a system. But we feel we are providing a value-added service to our residents — a service that some of our competitors do not have.
“If I were the director for an older building, and the owners wanted to install a system, I would definitely recommend that the owners do so,” said Logan. “If a wireless system made it easier and cheaper to install, it would make such a decision that much more appealing.”
The construction of hospitals, medical buildings, outpatient care clinics and other health-care facilities is picking up again after softening for two years. The health of this market has become more dependent on the major health-insurance providers that control so many of the facilities.
Source: McGraw-Hill Construction Information Group's 2002 Construction Outlook